Impact of donor comorbidities on heart transplant outcomes in the modern era

OBJECTIVES: The use of marginal donors with cardiovascular risk factors is increasing due to organ shortage but remains controversial in heart transplantation (HTx). We sought to investigate post-transplant outcomes in the recent era taking into account donor characteristics. METHODS: We reviewed 261 HTx performed in our hospital between January 1996 and March 2013. Donor characteristics were obtained from the national database. The incidence of primary graft dysfunction (PGD) and cardiac allograft vasculopathy (CAV) and overall survival were compared in 2 groups of HTx recipients: those receiving transplants from 1996 to 2004 (Group A, n = 120) and from 2005 to 2013 (Group B, n = 141). RESULTS: The mean age of the donors was 34 +/- 12 years in Group A vs 42 +/- 13 years in Group B (P < 0.001). Donors in Group B had a higher body mass index (23 +/- 2 vs 26 +/- 5 kg/m(2), P < 0.001), were more likely to be smokers (29.6% vs 52.9%, P < 0.001) and were more likely to have hypertension (5% vs 13.5%, P = 0.030). There was no difference in survival at 1 and 5 years (79% and 63% in Group A vs 80% and 62% in Group B, respectively; P = 0.551). The rate of PGD was 36% in Group A vs 40% in Group B (P = 0.092). Freedom from CAV at 5 years was 64% and 61%, respectively (P = 0.367). Among the characteristics of the donors, only hypertension was associated with reduced survival. CONCLUSIONS: The use of older cardiac donors with more cardiovascular comorbidities in the recent era did not impair the posttransplant outcomes. Donor hypertension was the only determinant of worse survival.