Heart transplantation using allografts from older donors: Multicenter study results
Por:
Roig, E, Alrnenar, L, Crespo-Leiro, M, Segovia, J, Mirabet, S, Delgado, J, Perez-Villa, F, Lambert, JL, Blasco, MT, Muniz, J
Publicada:
1 jun 2015
Resumen:
BACKGROUND: The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors >= 50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors.
METHODS: We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors >= 50 years old versus grafts from younger donors.
RESULTS: There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors >= 50 years old (Group II). Group I had more male donors than Group 11 (71% vs 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group If (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001).
CONCLUSIONS: There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients. J Heart Lung Transplant 2015;34:790-796 (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.
Filiaciones:
Roig, E:
Hosp Santa Creu & Sant Pau, Serv Cardiol, Barcelona, Spain
Alrnenar, L:
Hosp Univ & Politecn La Fe, Serv Cardiol, Valencia, Spain
Crespo-Leiro, M:
Hosp Univ A Coruna, Serv Cardiol, La Coruna, Spain
Segovia, J:
Clin Puerta de Hierro, Serv Cardiol, Madrid, Spain
Mirabet, S:
Hosp Santa Creu & Sant Pau, Serv Cardiol, Barcelona, Spain
Delgado, J:
Hosp 12 Octubre, Serv Cardiol, E-28041 Madrid, Spain
Perez-Villa, F:
Inst Clin Torax, Serv Cardiol, Barcelona, Spain
Lambert, JL:
Hosp Cent Asturias, Serv Cardiol, Asturias, Spain
Blasco, MT:
Hosp Miguel Servet, Serv Cardiol, Zaragoza, Spain
Muniz, J:
Univ A Coruna, Inst Ciencias Salud, La Coruna, Spain
Open Access
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