Use of Donor Hearts 250 Years Old for Septuagenarians in Heart Transplantation

BACKGROUND The impact of using donors 250 years old on heart transplantation outcomes of septuagenarians is unknown, which may have a potential to expand the donor pool.METHODS From January 2011 to December 2021, 817 septuagenarians received donor hearts <50 years old (DON<50) and 172 septuagenarians received donor hearts 250 years old (DON250) in the United Network for Organ Sharing database. Propensity score matching was performed using recipient characteristics (167 pairs). The Kaplan-Meier method and Cox proportional hazards model were used to analyze death and graft failure.RESULTS The number of heart transplants in septuagenarians has been increasing (54 per year in 2011 to 137 per year in 2021). In a matched cohort, the donor age was 30 years in DON<50 and 54 years in DON250. In DON250, cerebrovascular disease was the main cause of death (43%), whereas head trauma (38%) and anoxia (37%) were the causes in DON<50 (P < .001). The median heart ischemia time was comparable (DON<50, 3.3 hours; DON250, 3.2 hours; P = .54). In matched patients, 1-and 5-year survival rates were 88.0% (DON<50) vs 87.2% (DON250) and 79.2% (DON<50) vs 72.3% (DON250), respectively (log-rank, P = .41). In the multivariable Cox proportional hazards models, donors 250 years old were not associated with death in matched (hazard ratio, 1.05; 95% CI, 0.67-1.65; P = .83) and nonmatched groups (hazard ratio, 1.11; 95% CI, 0.82-1.50; P = .49).CONCLUSIONS The use of donor hearts older than 50 years can be an effective option for septuagenarians, thereby potentially increasing organ availability without compromising outcomes.