Impact of Donor and Recipient Age on 5-year Survival Following Heart Transplantation: A 24-year National Analysis from the United Kingdom

• Published in: The Journal of heart and lung transplantation Vol. 40; no. 4; p. S126
• Main Authors: Ali, J.M., Mumford, L., Smith, F., Stock, U., Mascaro, J., Curry, P., Venkateswaran, R., Clark, S., Parameshwar, J., Al-Attar, N., Berman, M.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2021
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2021.01.397

The impact of donor and recipient age on outcomes following heart transplantation remains controversial. The aim of this study was to evaluate the impact of donor and recipient age on 5-year survival following heart transplantation in the UK Data were extracted from the UK Transplant Registry held by NHS Blood and Transplant on 3192 adult (≥18) DBD heart transplants in the UK between 1995 and 2018 inclusive. Donors and recipients were divided into 3 age groups (18-40, 41-50, 51+ years) for analysis. Kaplan-Meier survival curves and Cox-proportional hazards models (adjusted for donor cause of death, donor BMI, recipient BMI, creatinine, VAD status, primary disease, sex mismatch, ischemia time, and OCS use) were used to estimate the effect of recipient and donor age on 5-year patient survival and survival conditional on 90-days The overall median recipient and donor age was 50 years and 38 years, respectively, with donor age increasing over time Un-adjusted analysis showed a significant difference in 5-year survival for both donor and recipient age groups, p<0.001 and p=0.005, respectively. After excluding patients who died within 90-days of surgery there was no longer a difference in outcome (Fig 1) Donor age, but not recipient age, was a predictor of inferior 5-year survival once added to a risk-adjusted model (p=0.008). A recipient receiving a heart from a donor aged 51+ had a 1.2 times higher risk of death than a recipient receiving an organ from a donor aged <40. After removing patients that had died within 90-days of transplant from the model, there was no longer a significant difference, indicating that the effect of donor age is only important short-term We have demonstrated that donor age is a statistically significant variable in modelling post heart transplant survival at 5 years. However, once a patient has survived the first three months post-transplant, donor age no longer significantly impacts on longer-term outcomes