title: Results with expanded donor acceptance criteria in heart transplantation.
abstract: OBJECTIVE
  Over the past years both donor and recipient profiles have changed in heart transplantation. Satisfactory clinical outcomes of marginal donors in candidates >60 years of age have led us to allocate suboptimal donors to younger recipients as well. Therefore, we retrospectively reviewed our experience.
  
  
  METHODS
  Among 199 patients undergoing heart transplantation from January 2000 to February 2010, there were 83 (41%) aged 61-72 years. The other 116 (59%) ranged in age between 18 and 60 years. According to their clinical conditions as heart transplantation candidates, They were classified into 4 groups: younger recipients (n=116) of either optimal donors (n=72; group 1 [G1]) or marginal donors (n=44; group 2 [G2]) and older recipients (n=83) of either marginal grafts (n=70, group 3 [G3]) or optimal grafts (n=13; group 4 [G4]). The gender distribution, cause of end-stage heart failure, preoperative pulmonary hypertension incidence, pretransplantation clinical status, and mean follow-up were not significantly different among the 4 groups.
  
  
  RESULTS
  Overall 30-day survival was 90 ± 1% and 10-year rate was 78 ± 9%. Among the groups, 30-day and 10-year actuarial survival rates were, respectively: 94 ± 4% and 87 ± 1% for G1; 86 ± 5% and 84 ± 7% for G2; 88 ± 4% and 71 ± 7% for G3 and were 100% and 82 ± 7% for G4 (P=.7). In comparison among the 4 groups, there was no significant difference regarding freedom from graft failure (P=.3), right ventricular failure (P=.3), acute rejection episodes (P = .2), chronic rejection (P=.2), neoplasia (P=.5), or chronic renal failure (P=.1). Older recipients of marginal donors [G3] had a 4% (n=3) prevalence of permanent pacemaker implant, versus G2: 3% (n=2) among (P=.1).
  
  
  CONCLUSIONS
  Our results suggest that extended donor and recipient criteria do not compromise clinical outcomes after transplantation.
authors.affiliation: Division of Cardiovascular Surgery, University of Verona, Verona, Italy. alberto.forni@ospedaleuniverona.it
authors.forename: A
authors.initials: A
authors.lastname: Forni
authors.forename: G B
authors.initials: GB
authors.lastname: Luciani
authors.forename: B
authors.initials: B
authors.lastname: Chiominto
authors.forename: M
authors.initials: M
authors.lastname: Pizzuti
authors.forename: A
authors.initials: A
authors.lastname: Mazzucco
authors.forename: G
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D046148:Donor Selection / Q000706:statistics & numerical data; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007558:Italy; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents