Impact of Donor and Recipient Age Difference on Survival after Heart Transplant

Background: The age gap between heart donors and recipients is a critical factor in deciding whether to accept or reject an offered organ for a patient. Transplanting older donor hearts often results in poorer survival outcomes, and such donor hearts are frequently deemed unsuitable for younger recipients. However, there is a dearth of data regarding the significance of age disparity for survival in heart transplantation.

Methods: From 2010 to 2024, a total of n = 336 donor hearts were transplanted at our center. Demographic and health-specific data of the patients were collected in a database and retrospectively analyzed. The age difference between donors and recipients was analyzed, comparing younger or older donor age to recipient age. Regarding the outcome, survival was identified using receiver operating characteristic curves (ROC), with the analysis performed individually for different recipient age groups. Best cut-off values were identified and employed for grouping in Kaplan-Meier analysis of overall survival.

Results: A total of n = 336 patients were included (54.8 years ± 11.8; 70.8% male). Median follow-up time was 2.5 years with no patients lost to follow-up. Mean donor age was 43.4 years ± 12.6. Donors were on average 11.5 years younger than recipients, with a wide age difference range from 51.0 years younger to 35.1 years older. As anticipated, younger heart transplant recipients, specifically those under 55 years of age, demonstrated improved overall survival outcomes compared with their older counterparts, without any notable differences based on gender (p = 0.04). Age difference was not associated with 30-day survival (AUC 0.61, p = 0.06), 1-year survival (AUC 0.57, p = 0.07), 3-year survival (AUC 0.53, p = 0.32), 7-year survival (AUC 0.56, p = 0.37), or overall survival. Donor age was independently associated with survival, with recipients of hearts from donors younger than 49.5 years showing better survival at 1 year (AUC 0.64, p < 0.01) and overall (p = 0.03). However, in recipients younger than 35 years old, there was a clear trend toward reduced survival when donors were more than 8.6 years older (AUC 0.79, p = 0.12).

Conclusion: As well known, the combination of an older donor organ with a younger recipient is generally associated with poorer outcomes. Our data suggest that the donor–recipient age gap does not significantly impact survival after heart transplantation within the first 7 years after transplantation, except for recipients younger than 35 years. This may warrant reconsidering the weight given to age difference when deciding on heart transplant acceptance.

Publication History

Article published online:
11 February 2025