The effect of donor and recipient age on outcome in cardiac transplantation

Objectives: Cardiac transplantation remains to be the treatment of choice for patients suffering from end-stage heart disease. Advances made in this field have led to improved survival rates and increased numbers of patients on the waiting list. Reclassification of selection criteria concerning donors and recipients poses an option to reduce the gap between necessity and availability of organs.

Methods: We retrospectively analyzed data of 751 cardiac transplant recipients treated at our centre between 1985 and 2009. Donor age was subdivided into <20 (n=164), 21–30 (n=206), 31–40 (n=161), 41–50 (n=160) and >51 (n=60), recipient age into <41 (n=158), 41–50 (n=207), 51–60 (n=295) and >60 (n=94) years. Monofactorial analysis of donor and recipient age groups was performed.

Results: Monofactorial analysis (Kaplan-Meier) of donor age showed no difference in survival (p=0.948). However Kaplan-Meier analysis of recipient age showed a significant difference (p=0.001) in survival, the best seen in recipients <40 years, the worst in recipients above the age of 60 years. Multifactorial analysis of outcome (Cox-Regression; Forward LR) regarding donor age, recipient age and interaction of both showed that only recipient age influenced survival significantly (p<0.001).

Conclusions: When allocating organs and choosing transplant candidates, recipient age has to play a greater role, whilst the caution with which older donors are treated could be slackened.