Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Transplant Proc. 2022 Oct;54(8):2088-2096. doi: 10.1016/j.transproceed.2022.07.004. Epub 2022 Oct 1.
Heart transplantation remains limited by donor availability. Currently, only some programs accept older donors, and their use remains contentious. We compared outcomes of heart transplant recipients who received donor hearts ≥55 years with those who received donor hearts <55 years.
Records of first-time adult heart transplant recipients between 2010 and 2019 were reviewed. Endpoints included 30-day and 1-, 3-, and 5-year survival; freedom from cardiac allograft vasculopathy; freedom from nonfatal major adverse cardiac events; and freedom from any rejections. The effect of donor age ≥55 years was analyzed with Cox proportional hazards modeling, 1:2 propensity score matching, and Kaplan-Meier survival analysis.
Sixty-six patients received donor hearts ≥55 years and 766 received donor hearts <55 years. In the unmatched cohort, there was no significant difference in survival between the 2 groups at 30 days (93.9% vs 97.3%, P = .127), 1 year (87.9% vs 91.6%, P = .325), 3 years (86.4% vs 86.5%, P = .888), or 5 years (78.8% vs 83.8%, P = .497). The ≥55 years group had a significantly lower freedom from cardiac allograft vasculopathy and fatal major adverse cardiac events. In propensity-matched patients, recipients of donors ≥55 years had similar survival and freedom from cardiac allograft vasculopathy but significantly lower 1-year (76.7% vs 88.3%, P = .026), 3-year (68.3% vs 84.2%, P = .010), and 5-year (63.3% vs 83.3%, P = .002) freedom from nonfatal major adverse cardiac events when compared to recipients of younger donors.
Carefully selected older donors can be considered for a carefully selected group of recipients with acceptable outcomes.
心脏移植仍然受到供体可用性的限制。目前，只有一些项目接受年龄较大的供体，但其使用仍存在争议。我们比较了接受年龄≥55 岁供体心脏和接受年龄<55 岁供体心脏的心脏移植受者的结局。
回顾了 2010 年至 2019 年期间首次接受成人心脏移植的患者记录。终点包括 30 天和 1、3 和 5 年生存率；免于心脏移植物血管病；免于非致命性主要不良心脏事件；以及免于任何排斥反应。采用 Cox 比例风险模型、1:2 倾向评分匹配和 Kaplan-Meier 生存分析分析供体年龄≥55 岁的影响。
66 例患者接受年龄≥55 岁供体心脏，766 例患者接受年龄<55 岁供体心脏。在未匹配队列中，两组在 30 天（93.9% vs 97.3%，P=0.127）、1 年（87.9% vs 91.6%，P=0.325）、3 年（86.4% vs 86.5%，P=0.888）和 5 年（78.8% vs 83.8%，P=0.497）时的生存率无显著差异。≥55 岁组心脏移植物血管病和致命性主要不良心脏事件的发生率显著降低。在倾向评分匹配的患者中，接受年龄≥55 岁供体心脏的患者生存率和免于心脏移植物血管病相似，但 1 年（76.7% vs 88.3%，P=0.026）、3 年（68.3% vs 84.2%，P=0.010）和 5 年（63.3% vs 83.3%，P=0.002）免于非致命性主要不良心脏事件的生存率显著降低。
对于经过精心挑选的受者，可以考虑使用经过精心挑选的老年供体，其结局可以接受。
