title: Outcomes in cardiac transplant recipients using allografts from older donors versus mortality on the transplant waiting list; Implications for donor selection criteria.
abstract: OBJECTIVE
  This study investigates the outcomes of cardiac transplantation using older donors.
  
  
  BACKGROUND
  Despite high mortality rates on waiting lists, transplanting hearts from older donors remains a relative contraindication.
  
  
  METHODS
  We retrospectively reviewed data on 479 adult heart transplant recipients, 352 status I patients, and 534 status II patients enrolled on a waiting list between 1992 and 1999. The Cox proportional hazards model was used for statistical analysis.
  
  
  RESULTS
  Of all donors, 20% were 40 to 50 years old and 8% were > or =50 years old. The risk of six-month mortality on the waiting list for patients who were not transplanted (status I: relative risk [RR] 8.5; status II: RR 3.7) significantly outweighed the risk of transplanting patients with a heart from donors >40 years old (status I: RR 1.6; status II: RR 2.1). Recipients of cardiac allografts from donors <40 years old had a one-month mortality rate of 5%, in contrast to 13% and 22% in those receiving allografts from donors 40 to 50 years old and > or =50 years old, respectively. Donor age did not influence long-term survival or frequency of rejections; however, it did correlate with the early presence of transplant-related coronary artery disease (TCAD). By the first annual angiogram, only 17% of recipients with donors <20 years old developed TCAD, in contrast to 26% to 30% and 34% of recipients who received allografts from donors age 20 to 40 years and >40 years, respectively.
  
  
  CONCLUSIONS
  Despite a strong association between older donor age and increased post-operative mortality and TCAD, it is more beneficial in terms of patient survival to receive an allograft from a donor >40 years old than to remain on the waiting list.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Columbia University, New York, New York 10032, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Lietz
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: Niloo M
authors.initials: NM
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006333:Heart Failure / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000401:mortality; D016896:Treatment Outcome; D014850:Waiting Lists