Impacto de la edad del donante-receptor en la supervivencia al trasplante cardiaco. Subanálisis del Registro Español de Trasplante Cardiaco

Heart Transplantation of the Elderly-Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

As society is ageing, an increasing prevalence of elderly heart failure patients will be expected. In order to increase the donor pool, acceptance of older donors might be a reasonable choice. All patients undergoing heart transplantation between 2010 and 2021 at a single department were retrospectively reviewed and divided into different study groups with regard to recipient (≤60 years (R^Y) or >60 years (R^O)) and donor age (≤50 years (D^Y) or >50 years (D^O). A total of n = 201 patients were included (D^Y/R^Y, n = 91; D^O/R^Y, n = 38; D^Y/R^O, n = 41; D^O/R^O, n = 31). Neither incidence of severe primary graft dysfunction (p = 0.64) nor adverse events, such as kidney failure (p = 0.27), neurological complications (p = 0.63), infections (p = 0.21) or acute graft rejection (p = 1.00), differed between the groups. However, one-year survival was impaired in the D^O/R^O group (56.0%) compared to the other groups (D^Y/R^Y: 86.1%, D^Y/R^O: 78.8%, D^O/R^Y: 74.2%, p = 0.02). Given the impaired one-year survival, acceptance of grafts from old donors for old recipients should be performed with caution and by experienced centres only. Nevertheless, because of the otherwise dismal prognosis of elderly heart failure patients, transplantation of patients may still improve the therapy outcome.

Spanish Heart Transplant Registry. 32nd Official Report of the Heart Failure Association of the Spanish Society of Cardiology

INTRODUCTION AND OBJECTIVES

The present report updates the main characteristics and outcomes of heart transplants in Spain to 2020.

METHODS

We describe the main features of recipients, donors, surgical procedure, and immunosuppression in 2020. We also analyze the temporal trends of these characteristics and outcomes (survival) for the period 2011 to 2019.

RESULTS

In 2020, 278 heart transplants were performed (7.3% decrease vs 2019). The findings in 2020 confirmed previous observations of an increase in pretransplant sternotomy, a slight decrease in urgent transplants carried out with ventricular assist devices, a slight decrease in donor age, an increase in the use of allografts with previous arrest, and a decrease in ischemia time. Survival continued to improve in recent triennia, reaching 82.0% at 1 year in the period 2017 to 2019.

CONCLUSIONS

The slight decrease in the number of heart transplants performed in 2020 in Spain, most likely due to the SARS-CoV-2 pandemic, did not change the main characteristics of the procedure. No change was observed in the tendency to improved survival.