A Very 37-Year Heart Transplantation Single-Center Experience: The Impact of Donor-Recipient Age Mismatch on Long-Term Outcomes.

Older heart donors (D) are associated to decreased survival after heart transplant (HT) both in older and younger recipients (R). However, the effect of age mismatched D-R pair on late-term survival is still a matter of debate. The aim of this study is to analyze late outcomes after HT in age mismatched D-R pairs compared to equal age matched pairs. We retrospectively analyzed all patients who underwent HT at our center between November 1985-September 2022. Long-term survival was compared among 4 subgroups matched according to their D-R age (D<50years-R>50years, Group 1; D>50years-R>50years, Group 2; D<50years-R<50years, Group 3; D>50years-R<50years, Group 4). Of 1058 patients enrolled during the study period, Group 1,2,3 and 4 included 417 (male D/R 65%/83%, median age D/R 35/58 years), 245 (male D/R 47%/82%, mean age D/R 58/62 years), 356 (male D/R 66%/80%, mean age D/R 22/38 years) and 40 (male D/R 38%/62%, mean age D/R 56/42 years) patients, respectively. 30-day mortality was not different among the 4 groups (p=0.487). At 37-year follow-up, Group 4 showed similar overall survival compared to Group 3 (p=0.324); Group 1 showed better survival compared to Group 2 (p=0.018). Regardless of recipient age, older donors were associated to similar late outcomes (Group 2 vs 4, p=0.676), whereas younger donors showed better late outcomes in younger recipients (Group 3 vs 1, p<0.001) (Figure 1). Severe cardiac allograft vasculopathy did not differ among the 4 groups (p=0.270) at the same follow-up time. Our experience suggests that D-R age mismatch does not affect early survival. At long-term follow-up, regardless of donor age, young recipients show similar long-term survival, whereas older recipients show better survival when receiving young donors. This study highlights the concept that additional unknown biological aging-related D-R factors might influence donor graft durability. [ABSTRACT FROM AUTHOR]