The Impact of Donor Age and Total Ischemic Time on Outcome after Heart Transplantation—A Single-Center Experience

Objectives: In times of organ shortage, the decision for refusal of organs has to be made carefully. It is still discussed controversially to which extent one can accept hearts from older donors or with expected prolonged ischemic times. Therefore we wanted to analyze the impact of donor age and ischemic time after heart transplantation (htx).

Methods: Between 2010 and July 2018, 108 patients underwent htx in our department.

The recipients were divided into four groups with regard to donor age and total ischemic time (TIT). Group 1 patients received hearts from donors < 50 years of age with a TIT below 240 minutes, in group 2 donor age was < 50 years and TIT ≥240 minutes (group 3: donors ≥50 years and TIT < 240 minutes, group 4 donors ≥50 years and TIT ≥240 minutes). The 4 groups were comparable regarding age, gender, prevalence of VAD pre-htx and further pretransplant status. We did not find additional donor-related differences in the groups. Group 1 served as a control group and was compared to all other groups.

Results: Group 1 consisted of 42 patients, group 2, 3 and 4 of 26, 35 and 5 patients. Thirty-day mortality was 2.4% in group 1, 7.7% in group 2, and significantly higher in groups 3 and 4 with 22.9 and 40% (p < 0.05).

Furthermore, 21.4% of group 1 patients needed extracorporeal life support (ECLS), compared with 38.5, 22.9, and 60% in groups 2, 3, and 4 (p = 0.08 for gr. 4). No significant differences were found with regard for resternotomy due to bleeding and further postoperative. Duration of postoperative stay on ICU or intermediate care ward and in hospital was comparable between the groups, however slightly shorter in group 3 (14.7 ± 11.3 days; 33.4 ± 20.5 days). Besides longest stay on ICU and in hospital, patients of group 4 displayed a longer need for mechanical ventilation, however without significance.

One-year-survival was 87.5% in group 1, 80, 59.4, and 60% in groups 2, 3, and 4, meaning a significant difference between groups 1 and 3.

Conclusion: With our results, we could show that a longer ischemic time is acceptable in younger donors. However, in donors older than 50 years organ acceptance should be made with great caution if the presumed ischemic time exceeds 4 hours. The decision mostly depends also on recipient’s status which may influence the willing to undergo an increased risk. In really marginal organs, the use of an organ care systems may be considered, particularly if a prolonged ischemic time is expected.