Effect of older donor age on risk for mortality after heart transplantation

Dipin Gupta, Valentino Piacentino, Mahender MacHa, Arun K. Singhal, John P. Gaughan, James B. McClurken, Bruce I. Goldman, Carol A. Fisher, Dan Beltramo, John Monacchio, Howard Eisen, Satoshi Furukawa

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Abstract

Background Despite the increasingly common use of donor hearts at least 50 years of age, controversy still remains regarding long-term outcome. Our goal was to determine if older donor age is associated with an increased risk of mortality and specifically if the use of donor hearts at least 50 years of age reduces survival. Methods We retrospectively studied records of all primary heart transplants performed between January 1990 and July 2002. Fifty-six patients who had received donor hearts at least 50 years of age were compared with 611 recipients of donor hearts less than 50 years of age. Clinicopathologic parameters were analyzed for their effect on mortality using the Cox proportional hazard model with calculation of hazard ratios (HR). Cut-point analysis of donor age was used to determine which donor age is associated with the greatest risk of mortality after transplant. Results Recipients of donor hearts at least 50 years of age were older (58.5 years ± 7.0 vs 53.2 ± 11.6; mean ± standard deviation [SD]; p < 0.0001), suffered more often from ischemic cardiomyopathy (69% vs 50%, p = 0.01), and experienced a longer waiting time (192.2 days ± 301.0 vs 138.6 ± 190.8, p < 0.0001). Donor hearts at least 50 years of age (age 54.1 ± 3.5 years) were more often female (50% vs 34%, p = 0.03), died less often of "head trauma" (9% vs 42%, p < 0.0001), and exhibited fewer cytomegalovirus (CMV) mismatches (29% vs 39%, p = 0.04) than donor hearts less than 50 years of age (age 26.8 ± 12.3 years). Multivariate predictors of mortality were rejection index (HR 1.90 per unit [rejections/100 survival days], p < 0.0001), donor age (HR 1.16 per 10-year increment, p = 0.002), and recipient age (HR 1.24 per 10-year increment, p = 0.04). Recipients of donor hearts at least 50 years of age had reduced 1-year and 5-year survival ([65.7% vs 81.7%, p < 0.05] and [48.3% vs 68.4%, p < 0.05], respectively), as well as a higher proportion of deaths occurring within 1 month of transplant (41% of total deaths vs 23%, p = 0.06). Cut-point analysis indicated the characteristic of donor age of at least 40 years (categorical variable) to predict mortality with the same degree of fit as age used as a continuous variable. Conclusions Although we observed a substantial reduction in survival among patients who were allocated donor hearts at least 50 years of age, this difference was not solely attributable to the categorical variable of donor age 50 in this group. Donor age as a continuous variable, however, was determined to be a notable predictor of survival and use of the donor age cut-point of 40 years (categorical variable) allowed risk stratification with similar accuracy. The use of a donor age cut-point of 40 years may be a useful clinical criterion for graft-related risk assessment.

Original languageEnglish (US)
Pages (from-to)890-899
Number of pages10
JournalAnnals of Thoracic Surgery
Volume78
Issue number3
DOIs
StatePublished - Sep 1 2004

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Heart Transplantation
Tissue Donors
Mortality
Survival
Transplants
Cytomegalovirus
Cardiomyopathies
Craniocerebral Trauma
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Gupta, D., Piacentino, V., MacHa, M., Singhal, A. K., Gaughan, J. P., McClurken, J. B., ... Furukawa, S. (2004). Effect of older donor age on risk for mortality after heart transplantation. Annals of Thoracic Surgery, 78(3), 890-899. https://doi.org/10.1016/j.athoracsur.2004.02.016
Gupta, Dipin ; Piacentino, Valentino ; MacHa, Mahender ; Singhal, Arun K. ; Gaughan, John P. ; McClurken, James B. ; Goldman, Bruce I. ; Fisher, Carol A. ; Beltramo, Dan ; Monacchio, John ; Eisen, Howard ; Furukawa, Satoshi. / Effect of older donor age on risk for mortality after heart transplantation. In: Annals of Thoracic Surgery. 2004 ; Vol. 78, No. 3. pp. 890-899.
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title = "Effect of older donor age on risk for mortality after heart transplantation",
abstract = "Background Despite the increasingly common use of donor hearts at least 50 years of age, controversy still remains regarding long-term outcome. Our goal was to determine if older donor age is associated with an increased risk of mortality and specifically if the use of donor hearts at least 50 years of age reduces survival. Methods We retrospectively studied records of all primary heart transplants performed between January 1990 and July 2002. Fifty-six patients who had received donor hearts at least 50 years of age were compared with 611 recipients of donor hearts less than 50 years of age. Clinicopathologic parameters were analyzed for their effect on mortality using the Cox proportional hazard model with calculation of hazard ratios (HR). Cut-point analysis of donor age was used to determine which donor age is associated with the greatest risk of mortality after transplant. Results Recipients of donor hearts at least 50 years of age were older (58.5 years ± 7.0 vs 53.2 ± 11.6; mean ± standard deviation [SD]; p < 0.0001), suffered more often from ischemic cardiomyopathy (69{\%} vs 50{\%}, p = 0.01), and experienced a longer waiting time (192.2 days ± 301.0 vs 138.6 ± 190.8, p < 0.0001). Donor hearts at least 50 years of age (age 54.1 ± 3.5 years) were more often female (50{\%} vs 34{\%}, p = 0.03), died less often of {"}head trauma{"} (9{\%} vs 42{\%}, p < 0.0001), and exhibited fewer cytomegalovirus (CMV) mismatches (29{\%} vs 39{\%}, p = 0.04) than donor hearts less than 50 years of age (age 26.8 ± 12.3 years). Multivariate predictors of mortality were rejection index (HR 1.90 per unit [rejections/100 survival days], p < 0.0001), donor age (HR 1.16 per 10-year increment, p = 0.002), and recipient age (HR 1.24 per 10-year increment, p = 0.04). Recipients of donor hearts at least 50 years of age had reduced 1-year and 5-year survival ([65.7{\%} vs 81.7{\%}, p < 0.05] and [48.3{\%} vs 68.4{\%}, p < 0.05], respectively), as well as a higher proportion of deaths occurring within 1 month of transplant (41{\%} of total deaths vs 23{\%}, p = 0.06). Cut-point analysis indicated the characteristic of donor age of at least 40 years (categorical variable) to predict mortality with the same degree of fit as age used as a continuous variable. Conclusions Although we observed a substantial reduction in survival among patients who were allocated donor hearts at least 50 years of age, this difference was not solely attributable to the categorical variable of donor age 50 in this group. Donor age as a continuous variable, however, was determined to be a notable predictor of survival and use of the donor age cut-point of 40 years (categorical variable) allowed risk stratification with similar accuracy. The use of a donor age cut-point of 40 years may be a useful clinical criterion for graft-related risk assessment.",
author = "Dipin Gupta and Valentino Piacentino and Mahender MacHa and Singhal, {Arun K.} and Gaughan, {John P.} and McClurken, {James B.} and Goldman, {Bruce I.} and Fisher, {Carol A.} and Dan Beltramo and John Monacchio and Howard Eisen and Satoshi Furukawa",
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Gupta, D, Piacentino, V, MacHa, M, Singhal, AK, Gaughan, JP, McClurken, JB, Goldman, BI, Fisher, CA, Beltramo, D, Monacchio, J, Eisen, H & Furukawa, S 2004, 'Effect of older donor age on risk for mortality after heart transplantation', Annals of Thoracic Surgery, vol. 78, no. 3, pp. 890-899. https://doi.org/10.1016/j.athoracsur.2004.02.016

Effect of older donor age on risk for mortality after heart transplantation. / Gupta, Dipin; Piacentino, Valentino; MacHa, Mahender; Singhal, Arun K.; Gaughan, John P.; McClurken, James B.; Goldman, Bruce I.; Fisher, Carol A.; Beltramo, Dan; Monacchio, John; Eisen, Howard; Furukawa, Satoshi.

In: Annals of Thoracic Surgery, Vol. 78, No. 3, 01.09.2004, p. 890-899.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of older donor age on risk for mortality after heart transplantation

AU - Gupta, Dipin

AU - Piacentino, Valentino

AU - MacHa, Mahender

AU - Singhal, Arun K.

AU - Gaughan, John P.

AU - McClurken, James B.

AU - Goldman, Bruce I.

AU - Fisher, Carol A.

AU - Beltramo, Dan

AU - Monacchio, John

AU - Eisen, Howard

AU - Furukawa, Satoshi

PY - 2004/9/1

Y1 - 2004/9/1

N2 - Background Despite the increasingly common use of donor hearts at least 50 years of age, controversy still remains regarding long-term outcome. Our goal was to determine if older donor age is associated with an increased risk of mortality and specifically if the use of donor hearts at least 50 years of age reduces survival. Methods We retrospectively studied records of all primary heart transplants performed between January 1990 and July 2002. Fifty-six patients who had received donor hearts at least 50 years of age were compared with 611 recipients of donor hearts less than 50 years of age. Clinicopathologic parameters were analyzed for their effect on mortality using the Cox proportional hazard model with calculation of hazard ratios (HR). Cut-point analysis of donor age was used to determine which donor age is associated with the greatest risk of mortality after transplant. Results Recipients of donor hearts at least 50 years of age were older (58.5 years ± 7.0 vs 53.2 ± 11.6; mean ± standard deviation [SD]; p < 0.0001), suffered more often from ischemic cardiomyopathy (69% vs 50%, p = 0.01), and experienced a longer waiting time (192.2 days ± 301.0 vs 138.6 ± 190.8, p < 0.0001). Donor hearts at least 50 years of age (age 54.1 ± 3.5 years) were more often female (50% vs 34%, p = 0.03), died less often of "head trauma" (9% vs 42%, p < 0.0001), and exhibited fewer cytomegalovirus (CMV) mismatches (29% vs 39%, p = 0.04) than donor hearts less than 50 years of age (age 26.8 ± 12.3 years). Multivariate predictors of mortality were rejection index (HR 1.90 per unit [rejections/100 survival days], p < 0.0001), donor age (HR 1.16 per 10-year increment, p = 0.002), and recipient age (HR 1.24 per 10-year increment, p = 0.04). Recipients of donor hearts at least 50 years of age had reduced 1-year and 5-year survival ([65.7% vs 81.7%, p < 0.05] and [48.3% vs 68.4%, p < 0.05], respectively), as well as a higher proportion of deaths occurring within 1 month of transplant (41% of total deaths vs 23%, p = 0.06). Cut-point analysis indicated the characteristic of donor age of at least 40 years (categorical variable) to predict mortality with the same degree of fit as age used as a continuous variable. Conclusions Although we observed a substantial reduction in survival among patients who were allocated donor hearts at least 50 years of age, this difference was not solely attributable to the categorical variable of donor age 50 in this group. Donor age as a continuous variable, however, was determined to be a notable predictor of survival and use of the donor age cut-point of 40 years (categorical variable) allowed risk stratification with similar accuracy. The use of a donor age cut-point of 40 years may be a useful clinical criterion for graft-related risk assessment.

AB - Background Despite the increasingly common use of donor hearts at least 50 years of age, controversy still remains regarding long-term outcome. Our goal was to determine if older donor age is associated with an increased risk of mortality and specifically if the use of donor hearts at least 50 years of age reduces survival. Methods We retrospectively studied records of all primary heart transplants performed between January 1990 and July 2002. Fifty-six patients who had received donor hearts at least 50 years of age were compared with 611 recipients of donor hearts less than 50 years of age. Clinicopathologic parameters were analyzed for their effect on mortality using the Cox proportional hazard model with calculation of hazard ratios (HR). Cut-point analysis of donor age was used to determine which donor age is associated with the greatest risk of mortality after transplant. Results Recipients of donor hearts at least 50 years of age were older (58.5 years ± 7.0 vs 53.2 ± 11.6; mean ± standard deviation [SD]; p < 0.0001), suffered more often from ischemic cardiomyopathy (69% vs 50%, p = 0.01), and experienced a longer waiting time (192.2 days ± 301.0 vs 138.6 ± 190.8, p < 0.0001). Donor hearts at least 50 years of age (age 54.1 ± 3.5 years) were more often female (50% vs 34%, p = 0.03), died less often of "head trauma" (9% vs 42%, p < 0.0001), and exhibited fewer cytomegalovirus (CMV) mismatches (29% vs 39%, p = 0.04) than donor hearts less than 50 years of age (age 26.8 ± 12.3 years). Multivariate predictors of mortality were rejection index (HR 1.90 per unit [rejections/100 survival days], p < 0.0001), donor age (HR 1.16 per 10-year increment, p = 0.002), and recipient age (HR 1.24 per 10-year increment, p = 0.04). Recipients of donor hearts at least 50 years of age had reduced 1-year and 5-year survival ([65.7% vs 81.7%, p < 0.05] and [48.3% vs 68.4%, p < 0.05], respectively), as well as a higher proportion of deaths occurring within 1 month of transplant (41% of total deaths vs 23%, p = 0.06). Cut-point analysis indicated the characteristic of donor age of at least 40 years (categorical variable) to predict mortality with the same degree of fit as age used as a continuous variable. Conclusions Although we observed a substantial reduction in survival among patients who were allocated donor hearts at least 50 years of age, this difference was not solely attributable to the categorical variable of donor age 50 in this group. Donor age as a continuous variable, however, was determined to be a notable predictor of survival and use of the donor age cut-point of 40 years (categorical variable) allowed risk stratification with similar accuracy. The use of a donor age cut-point of 40 years may be a useful clinical criterion for graft-related risk assessment.

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Gupta D, Piacentino V, MacHa M, Singhal AK, Gaughan JP, McClurken JB et al. Effect of older donor age on risk for mortality after heart transplantation. Annals of Thoracic Surgery. 2004 Sep 1;78(3):890-899. https://doi.org/10.1016/j.athoracsur.2004.02.016