Heart transplantation with super-aged donors older than 65 years
Tasuku Hada, MD,
Osamu Seguchi, MD, PhD,
Nana Kitahata, CE,
Shotaro Komeyama, MD,
Hiroki Mochizuki, MD,
Takuya Watanabe, MD, PhD,
Satoshi Kainuma, MD, PhD,
Satsuki Fukushima, MD, PhD,
Yasumasa Tsukamoto, MD, PhD,
Tomoyuki Fujita, MD, PhD,
Jon Kobashigawa, MD,
Norihide Fukushima, MD, PhD
Affiliations
Tasuku Hada, MD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Osamu Seguchi, MD, PhD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Corresponding author: Osamu Seguchi, MD, Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
Nana Kitahata, CE
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Shotaro Komeyama, MD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Hiroki Mochizuki, MD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Takuya Watanabe, MD, PhD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Satoshi Kainuma, MD, PhD
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Satsuki Fukushima, MD, PhD
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Yasumasa Tsukamoto, MD, PhD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Tomoyuki Fujita, MD, PhD
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
Jon Kobashigawa, MD
Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
Norihide Fukushima, MD, PhD
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Senri Kinran University, Suita, Osaka, Japan
Background: This study elucidated the clinical outcomes and serial allograft function of heart transplant (HTx) recipients who received hearts from super-aged donors (SAD) ≥65 years of age. Methods: Adult HTx recipients between 1999 and 2022 were retrospectively reviewed and divided into 2: donor age ≥65 years [SAD group (n = 12)] and donor age <65 years [younger donor, YD group (n = 140)]. The primary end-point was 3-year all-cause deaths after HTx. Secondary end-points included all-cause death, hospitalization due to heart failure, acute cellular rejection, coronary intervention, and electronic device implantation. Serial cardiac function was assessed using echocardiography and right heart catheterization. Results: Compared with the recipients in the YD group, those in the SAD group were older [age, 60 (interquartile range (IQR): 46-63) vs 42 (IQR: 31-52) years, p < 0.001], had a higher E/e’ and lower cardiac index (CI) 1 month after HTx [E/e’, 12.5 (IQR: 9.0-16.8) vs 9.5 (IQR: 7.5-11.9), p = 0.026; CI, 2.8 (IQR: 2.4-3.2) liter/min/m² vs 3.3 (IQR: 2.9-3.9) liter/min/m², p = 0.014], and a comparable CI with higher E/e’ 1 year after HTx [E/e’, 12.0 (IQR: 8.6-13.3) vs 7.9 (IQR: 6.6-10.6), p = 0.007; CI, 3.6 (IQR: 3.2-4.3) liter/min/m² vs 3.6 (IQR: 3.3-4.2) liter/min/m², p = 0.99]. The 3-year overall survival was lower in the SAD group than in the YD group (81.5% vs 97.8%, p = 0.006), whereas the secondary end-points were comparable. Conclusion: SAG hearts at ≥65 years can be used for HTx with acceptable outcomes and feasible allograft function in relatively older recipients.
