Introduction

Utilization of heart from older donors is variable across centers with uncertain outcomes of recipients. We sought to utilize a national registry to examine usage and outcomes of heart transplant recipients from older donors. We also explored the impact of current donor heart allocation scheme on outcomes of hearts from older donors.

Methods

This observational study utilized the United Network for Organ Sharing database between 2015 and 2023 with donors categorized into age < 45 years or ≥ 45 years and evaluated organ disposition and geographical variation. 30-day, 1- and 3- year mortality, and graft failure rates were compared amongst recipients as per donor age group. We also evaluated annual trends in HT for each group over the follow-up period.

Results

24,966 adult donors were recovered: 3,742 (15.0%) were ≥ 45 years; 3,349 (15.6%) adults received heart from such donors with significant geographical variation, and a declining utilization in the transplantation rate in current donor allocation system. Donors with age ≥ 45 years had higher comorbidities and were allotted with a significantly shorter ischemic time to recipients who were significantly less likely to receive temporary mechanical circulatory support and more likely female. Unadjusted and adjusted, 30-day mortality were similar but 1- and 3-year mortality and graft failure rates were significantly higher in recipients of such donors. spline analysis suggested a higher 1-year mortality risk at older donor age with risk increasing after age 40 years.

Conclusions

Older donor age was associated with worsened 1- and 3-year mortality and graft failure for heart transplant recipients.

中文翻译：

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使用老年捐献者与心脏移植后较高的死亡率相关：UNOS 观察性研究

介绍

不同中心对老年捐献者心脏的利用情况各不相同，受赠者的结果也不确定。我们试图利用国家登记处来检查老年捐赠者心脏移植受者的使用情况和结果。我们还探讨了当前捐赠者心脏分配方案对老年捐赠者心脏结果的影响。

方法

这项观察性研究利用了 2015 年至 2023 年间器官共享联合网络数据库，将捐赠者分为年龄 < 45 岁或 ≥ 45 岁，并评估了器官配置和地理差异。按供体年龄组比较受者之间的 30 天、1 年和 3 年死亡率以及移植失败率。我们还评估了后续期间各组 HT 的年度趋势。

结果

回收成年捐献者 24,966 名，其中 3,742 名（15.0%）≥ 45 岁；3,349 名（15.6%）成年人接受了此类捐赠者的心脏，其地域差异显着，并且在当前捐赠者分配系统中移植率的利用率正在下降。年龄≥ 45 岁的捐赠者有较高的合并症，并且为接受临时机械循环支持的可能性明显较小且更可能为女性的受者分配了显着更短的缺血时间。未经调整和调整后，此类供体的受者的 30 天死亡率相似，但 1 年和 3 年死亡率以及移植失败率显着更高。样条分析表明，供体年龄较大的 1 年死亡风险较高，40 岁后风险增加。

结论

供体年龄较大与心脏移植受者的 1 年和 3 年死亡率以及移植失败相关。