Iyanna Nidhi, Hong Yeahwa, Hess Nicholas R, Ziegler Luke A, Dorken-Gallastegi Ander, Hickey Gavin W, Keebler Mary E, Kaczorowski David J
School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Transplantation. 2025 Mar 1;109(3):549-557. doi: 10.1097/TP.0000000000005194. Epub 2024 Aug 28.
This study evaluates the interaction of donor and recipient age with outcomes following heart transplantation under the 2018 heart allocation system.
The United Network for Organ Sharing registry was queried to analyze adult primary isolated orthotopic heart transplant recipients and associated donors from August 18, 2018, to June 30, 2021. Both recipient and donor cohorts were grouped according to age: <65 and ≥65 y for recipients and <50 and ≥50 y for donors. The primary outcome was survival. Subanalyses were performed to evaluate the impact of donor age.
A total of 7601 recipients and 7601 donors were analyzed. Of these, 1584 recipients (20.8%) were ≥65 y old and 560 donors (7.4%) were ≥50 y old. Compared with recipients <65, recipients ≥65 had decreased 1-y (88.8% versus 92.3%) and 2-y (85.1% versus 88.5%) survival rates ( P < 0.001). The association of recipient age ≥65 with lower survival persisted after adjusting for potential cofounders (hazard ratio, 1.38; 95% confidence interval, 1.18-1.61; P < 0.001). Recipients <65 with donors ≥50 had comparable 1-y and 2-y survival rates to recipients <65 with donors <50 ( P = 0.997). Conversely, transplantation of older allografts was associated with lower 1-y (84.2% versus 89.4%) and 2-y (79.5% versus 85.8%) survival rates in recipients ≥65 ( P = 0.025).
Recipient age ≥65 continues to be associated with worse survival following heart transplantation in the 2018 heart allocation system compared with younger recipients. Donors ≥50 may be acceptable among recipients <65 with comparable outcomes. However, careful donor age selection should be considered for recipients ≥65, as the use of younger donor allografts appears to improve posttransplantation survival.
本研究评估了在2018年心脏分配系统下，供体和受体年龄与心脏移植术后结局之间的相互作用。
查询器官共享联合网络登记处，分析2018年8月18日至2021年6月30日期间的成年原发性孤立原位心脏移植受者及相关供体。根据年龄对受体和供体队列进行分组：受体分为<65岁和≥65岁，供体分为<50岁和≥50岁。主要结局为生存率。进行亚组分析以评估供体年龄的影响。
共分析了7601名受体和7601名供体。其中，1584名受体（20.8%）年龄≥65岁，560名供体（7.4%）年龄≥50岁。与<65岁的受体相比，≥65岁的受体1年生存率（88.8%对92.3%）和2年生存率（85.1%对88.5%）降低（P<0.001）。在对潜在混杂因素进行校正后，年龄≥65岁的受体与较低生存率之间的关联仍然存在（风险比，1.38；95%置信区间，1.18 - 1.61；P<0.001）。<65岁且供体≥50岁的受体的1年和2年生存率与<65岁且供体<50岁的受体相当（P = 0.997）。相反，在≥65岁的受体中，使用较老的移植物与较低的1年生存率（84.2%对89.4%）和2年生存率（79.5%对85.8%）相关（P = 0.025）。
与年轻受体相比，在2018年心脏分配系统中，年龄≥65岁的受体心脏移植后的生存率仍然较差。对于<65岁且结局相当的受体，≥50岁的供体可能是可以接受的。然而，对于≥65岁的受体，应谨慎选择供体年龄，因为使用较年轻的供体移植物似乎可以提高移植后的生存率。
