title: Heart transplantation using allografts from older donors: Multicenter study results.
abstract: BACKGROUND
  The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors.
  
  
  METHODS
  We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors.
  
  
  RESULTS
  There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs. 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001).
  
  
  CONCLUSIONS
  There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.
authors.affiliation: Servicio de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: eroigm@santpau.cat.
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Roig
authors.affiliation: Servicio de Cardiologia, Hospital Universitario y Politecnico La Fe, Valencia, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Almenar
authors.affiliation: Servicio de Cardiologia, Hospital Universitario A Coruña, A Coruña, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Crespo-Leiro
authors.affiliation: Servicio de Cardiologia, Clinica Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
authors.affiliation: Servicio de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Sònia
authors.initials: S
authors.lastname: Mirabet
authors.affiliation: Servicio de Cardiologia, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Servicio de Cardiologia, Institut Clínic del Torax, Barcelona, Spain.
authors.forename: Felix
authors.initials: F
authors.lastname: Pérez-Villa
authors.affiliation: Servicio de Cardiologia, Hospital Central de Asturias, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Luís Lambert
authors.affiliation: Servicio de Cardiologia, Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Teresa Blasco
authors.affiliation: Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: HTx prognosis; cardiac allograft vasculopathy; heart transplantation; older donors; survival after HTx