Impact of donor quality on outcome of heart transplantation

Objective: Over the last few years, there have been changes in both donor and recipient profiles in heart transplantation. Encouraging clinical outcome of marginal donors in candidates older than 60 years of age led us to allocate suboptimal donors for younger recipients as well. We reviewed our experience retrospectively so as to assess the impact of donor quality on heart transplantation. Methods: Among 181 patients who underwent heart transplantation between January 2000 and February 2009, there were 75 patients (41%) aged 61–70 years and 106 patients (59%) ranging in age between 18 and 60 years. According to the recipient's age, they were classified into four groups. The younger recipients (106 patients) had either optimal donors (70 patients, group 1) or marginal donors (36 patients, group 2). The older recipients (75 patients) had either marginal grafts (64 patients, group 3) or optimal grafts (11 patients, group 4). Sex distribution, cause of end-stage heart failure, preoperative pulmonary hypertension, pre-heart-transplantation clinical status or mean follow-up duration did not show any statistically significant difference among the four groups. Results: Overall, the 9-year actuarial survival rate was 78% ± 1%. The 30 days and 9-year actuarial survival rates were 94% ± 2% and 80% ± 1% in group 1; 86% ± 5% and 55% ± 12% in group 2; 90% ± 4% and 73% ± 7% in group 3; 99% ± 1% and 82% ± 7% in group 4 (P = 0.07). Comparison among the four groups did not show any statistical difference in terms of freedom from graft failure (P = 0.3), right ventricular failure (P = 0.3), acute rejection (P = 0.2), chronic rejection (P = 0.2), neoplasia (P = 0.5) and chronic renal failure (P = 0.2). Older recipients of marginal donors (group 3) had slightly higher prevalence of permanent pacemaker implants: eight permanent pacemakers versus two in group 2, and none in group 1 and group 4 (P = 0.4). Conclusions: Our results suggest that extended donor acceptance criteria may not compromise clinical outcome after heart transplantation. Further follow-up is warranted.