title: The policy of placing older donors into older recipients: is it worth the risk?
abstract: BACKGROUND
  To expand the donor pool, older donors (≥50 yr) are frequently used in older recipients (≥60 yr). Older recipients and those receiving older donor hearts have independently displayed decreased post-transplant survival. However, outcomes in older patients receiving older donor hearts are contentious.
  
  
  METHODS
  Eight hundred and seventy-nine heart transplant patients between 2000 and 2010 were analyzed, excluding patients with donor coronary artery disease. From 380 patients ≥60 yr, 327 patients with donors <50 yr old were compared with 53 patients with donors ≥50 yr old for: five-yr actuarial survival, freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30%), non-fatal major adverse cardiac events (NF-MACE: MI, CHF, stroke, need for pacemaker/ICD), one-yr freedom from any treated rejection.
  
  
  RESULTS
  The older vs. younger donor group demonstrated significantly lower five-yr survival (57% vs. 85%, p < 0.001) and freedom from CAV (83% vs. 92%, p = 0.03). No difference was observed in five-yr freedom from NF-MACE and one-yr freedom from any treated rejection. Multivariate analysis found donor age ≥50 to be an independent risk factor for death (HR 1.8, CI 1.1-2.9, p = 0.008) and CAV (HR 1.9, CI 1.2-2.9, p = 0.004).
  
  
  CONCLUSIONS
  Use of older donors (≥50 yr) in older recipients (≥60 yr) results in lower five-yr survival and freedom from CAV. Caution is required in these cases. Larger studies are warranted to confirm findings.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Yonah Solaiman
authors.initials: YS
authors.lastname: Tehrani
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yu
authors.forename: Minh
authors.initials: M
authors.lastname: Luu
authors.forename: Frank
authors.initials: F
authors.lastname: Liou
authors.forename: Matthew
authors.initials: M
authors.lastname: Rafiei
authors.forename: Michele
authors.initials: M
authors.lastname: Hamilton
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006331:Heart Diseases / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors
keywords: cardiac allograft vasculopathy; cardiac transplantation; older donors; older recipients; outcomes; rejection; survival