Interaction Between Ischemic Time and Donor Age on Adult Heart Transplant Outcomes in the Modern Era

Background: Tolerance of donor hearts of different ABO blood types to allograft ischemic time has not been previously examined. Objectives: We determined the impact of allograft ischemic time on heart transplant outcomes with differing ABO donor organ types. Methods: We identified 32,454 heart transplants (2000-2016) from the United Network for Organ Sharing database. Continuous variables were analyzed with t-test and categorical variables were compared with Chi-squared test. Survival was determined using log-rank or Cox regression tests. Propensity matching adjusted for preoperative variables. Results: Comparing allograft ischemic times <4 hours (hr, n=6579) versus ≥4hr (n=25,875), the odds ratio (OR) for death at 15 years following prolonged allograft ischemic time (≥4hrs) for blood type O, A, B, and AB were 1.106 (P<0.001), 1.062 (P<0.001), 1.059 (P=0.062), 1.114 (P=0.221), respectively. Unadjusted data demonstrated higher mortality for transplantation of O versus non-O donor hearts for allograft ischemic times ≥4 hours (OR=1.164, P<0.001). Following propensity matching, O donor hearts continued to have worse survival if preserved for ≥4hrs (OR=1.137, P=0.008), but not if allograft ischemic time was <4hrs (OR=1.042, P=0.113). In a matched group with ≥4hrs of allograft ischemic time, patients receiving O donor organs were more likely to experience death from primary allograft dysfunction (2.5% vs 1.7%, P=0.052) and chronic allograft rejection (1.9% versus 1.1%, P=0.021). No difference in death from primary allograft graft dysfunction or chronic allograft rejection was seen with <4hr of allograft ischemic time (P>0.150). Conclusions: Compared with non-O hearts, transplantation with O donor hearts stored for ≥4hrs leads to worse survival, with higher rates of primary graft dysfunction and chronic rejection. Caution should be practiced when considering donor hearts with the O blood type when extended cold preservation times are anticipated.

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Height mismatch: An overlooked component of adult heart transplant outcomes

Clinical Transplantation ◽

10.1111/ctr.13863 ◽

2020 ◽

Vol 34 (6) ◽

Author(s):

Sarah E. Rudasill ◽

Yas Sanaiha ◽

Alexandra L. Mardock ◽

Hanning Xing ◽

Habib Khoury ◽

...

Keyword(s):

Heart Transplant ◽

Adult Heart ◽

Transplant Outcomes

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Impact of donor comorbidities on heart transplant outcomes in the modern era

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx014 ◽

2017 ◽

Vol 24 (6) ◽

pp. 898-904 ◽

Cited By ~ 6

Author(s):

Julien Guihaire ◽

Pierre Emmanuel Noly ◽

Amandine Martin ◽

Mathilde Rojo ◽

Marie Aymami ◽

...

Keyword(s):

Heart Transplant ◽

Transplant Outcomes ◽

Modern Era

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Impact of Pre-Transplant Ventricular Assist Device Implantation on Adult Heart Transplant Outcomes in a Commercially Insured Population

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.06.287 ◽

2015 ◽

Vol 21 (8) ◽

pp. S96-S97

Author(s):

Wade Bannister ◽

Charlotte Wu ◽

Jiang Tao ◽

Frank D. Irwin

Keyword(s):

Heart Transplant ◽

Ventricular Assist Device ◽

Assist Device ◽

Ventricular Assist ◽

Adult Heart ◽

Transplant Outcomes ◽

Device Implantation

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Systematic Assessment of Safety Threshold for Donor Age in Cadaveric Liver Transplantation

Frontiers in Medicine ◽

10.3389/fmed.2021.596552 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wenchao Wang ◽

Zhengtao Liu ◽

Junjie Qian ◽

Jun Xu ◽

Shuping Que ◽

...

Keyword(s):

Liver Transplantation ◽

Dependent Manner ◽

Donor Age ◽

Ischemic Time ◽

Quantitative Evidence ◽

Systematic Assessment ◽

Post Transplant ◽

Transplant Outcomes ◽

Cold Ischemic Time ◽

Age Related

Background: Donor age affects allograft quality and the prognosis of recipients after liver transplantation (LT). Clinicians have assessed the quality of grafts from older donors based on their appearance and texture, with no reliable quantitative evidence. Our study aimed to assess the quantitative impact of donor age on post-transplant outcomes and its safety threshold for LT, based on the published literature.Methods: Relevant studies were retrieved from the Embase, PubMed, and ISI Web of Science databases. Pooled dichotomous relative risks (RRs) were calculated using metan. Continuous RRs were calculated using a two-stage random-effects model.Results: Eleven studies including 30,691 LT cases were included for further analysis. For categorical comparison, the RR of death within the first post-transplant year was significantly higher among patients who received grafts from older donors. Similarly, the RR of graft failure (GF) was increased within the 3 years after transplantation. For continuous comparison, advanced donor age affected transplant outcomes in a linear manner (P > 0.05). A 10-year increment in donor age was associated with RRs 1.10, 1.12, 1.15, 1.10, and 1.08 for 90-day, 180-day, 1-year, 3-year, and 5-year patient mortality and 1.08, 1.06, 1.10, 1.11, and 1.12, for 90-day, 180-day, 1-year, 2-year, and 3-year GF, respectively (all P < 0.05). A spline model showed that transplants using grafts from donors <43 years old were not associated with age-related risks (P > 0.05). The risk of GF was increased in subgroups with fewer LT cases, longer cold ischemic time, fewer male donors, and recipients with viral hepatitis (P < 0.05).Conclusion: Donor age might affect post-LT outcomes in a dose-dependent manner. The safety threshold for donor age in terms of GF should be lowered to 43 years as an early warning for the guarantee of satisfactory outcomes. Clinicians should weigh the benefits against the risks carefully for patients receiving grafts from older donors. Further studies are warranted to investigate the mechanisms responsible for the relationship between donor age and graft quality.

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