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Heart Transplant Recipient and Donor Age: Should the Younger Recipient Be Matched with the Younger Donor?
Abstracts
S161 375 Time to death and graft failure Death
Height ratio Weight ratio BMI ratio LV mass ratio
Graft Failure
Odds ratio
95% CI
P-value
Odds ratio
95% CI
P-value
1.08 0.94 0.93 1.00
0.90-1.29 0.81-1.10 0.81-1.08 0.85-1.18
0.44 0.45 0.33 0.98
1.08 0.95 0.93 1.01
0.90-1.29 0.82-1.10 0.81-1.08 0.85-1.19
0.41 0.47 0.34 0.95
374 Mitigating the Impact of Gender Mismatch in Heart Transplantation Using BMI and BSA Ratios Y.D. Barac, O. Jawitz, V. Raman, M. Hartwig, J. Klapper, J. Schroder, M. Daneshmand, C. Patel and C. Milano. Duke University Medical Center, Durham, NC. Purpose: Heart transplantation is limited by the supply of donor organs. Previous studies have associated donor/recipient gender mismatch with decreased post-transplant survival and increased rates of primary graft dysfunction. We evaluate whether this risk can be mitigated. Methods: We performed a retrospective analysis of the OPTN/UNOS registry encompassing years 1987 to 2018 for all male adult recipients (>18 years) who underwent isolated heart transplantation with grafts from female donors. Comparison was made to transplants from male donors. Recipients were primarily stratified into two groups, those with BMI less than or greater than donor BMI. Patients were stratified by BSA on secondary analysis. Kaplan-Meier analysis was used to estimate survival post-transplant. Cox Proportional Hazards modeling was performed to identify independent predictors of survival. Results: A total of 8,232 candidates met inclusion criteria. Male recipients receiving hearts from higher BMI female donors were more likely to be in the ICU pre-transplant (39.5% vs 36.6%, p = 0.001), on IV inotropes at listing (35.7% vs 33.0%, p = 0.013), and were less likely to have a history of diabetes (21.4% vs 23.9%, p = 0.012). On Kaplan-Meier analysis, recipients transplanted with hearts from higher BMI female donors had improved overall survival. When stratified by BSA (Figure 1), male recipients transplanted with hearts from higher BSA female donors had similar post-transplant survival as male recipients who received hearts from male donors. On Cox Proportional Hazards analysis, increased donor BMI/BSA relative to recipient BMI/ BSA remained an independent predictor of improved survival (p < 0.05). Conclusion: Prior studies have associated transplanting hearts from female donors into male recipients with decreased post-transplant survival. In this study we have demonstrated that this may be mitigated by matching grafts from female donors to male recipients with lower BMI and especially BSA.
Characteristics and Short-Term Outcomes of Hepatitis C Antibody Positive Organs for Heart Transplantation: UNOS Analysis E.M. DeFilippis, R.C. Givens, A.R. Garan, F. Latif, S.W. Restaino, Y. Naka, K. Takeda, H. Takayama, P.C. Colombo, M.A. Farr and V.K. Topkara. Columbia University Medical Center, New York, NY. Purpose: Heart transplant centers are increasingly utilizing organs from donors infected with Hepatitis C virus (HCV). Aside from single-center experiences, there is little existing data regarding the characteristics of recipients of HCV Antibody (Ab)+ organs as well as short-term outcomes and graft survival. Methods: We analyzed the United Network for Organ Sharing registry from January 2016 and March 2018 to include adults ≥18 who had undergone heart transplantation with a HCV Ab+ donor. Information regarding nucleic acid amplification testing (NAT) was also available. Results: Between January 2016 and March 2018, 159 recipients underwent heart transplantation with HCV Ab+ donors. When comparing recipients of HCV+ to HCV- hearts, there were no differences between recipient age (53.4 vs 53.6 years, p =0.86), donor age (33.2 vs 31.9 years, p =0.055), female donor (26.0 vs 27.7%, p =0.64), body mass index (27.3 vs 27.6, p =0.47), and serum creatinine at transplant (1.4 vs 1.4, p = 0.36). There were no differences in the use of ventricular assist devices at time of transplant between groups. Recipients of HCV+ organs were more likely to be Blood Type O (55.3% vs 38.9%, p <0.001) and spent significantly fewer days as Status 1A (25.8 vs 42.6, p <0.001). Recipients of HCV+ organs had longer ischemic times (3.6 vs 3.0 hours, p <0.001) with associated longer distances from the donor hospital to the transplant center (323 vs 146 miles, p<0.001). Kaplan-Meier survival curves showed a trend towards decreased survival in the HCV+ group when compared to the HCV- group (p =0.06). Among recipients of HCV+ organs, there was no difference in survival between recipients of NAT+ and NAT- donors (Figure). Conclusion: While recipient baseline characteristics were similar between those receiving HCV+ and HCV- transplants, recipients of HCV+ organs had significantly longer ischemic times with longer distances from the donor hospital to the transplant center. Short-term survival appears similar between groups.
376 Heart Transplant Recipient and Donor Age: Should the Younger Recipient Be Matched with the Younger Donor? Y. Ravi,1 N. Srikanth,2 I.W. Paul,3 B.A. Whitson,4 S. Emani,5 and C.B. SaiSudhakar.1 1Cardiac Surgery, Scott & White, Texas A&M, Temple, TX; 2 Medical Student, Saveetha Institute of Medical Sciences, Chennai, India; 3 Medical Student, Sree Mookambika Institute of Medical Sciences, Kulasekaram, India; 4Cardiac Surgery, The Ohio State University, Columbus, OH; and the 5Internal Medicine, The Ohio State University, Columbus, OH. Purpose: With the shortage of donor hearts, older donors are being increasingly evaluated for potential recipients. Currently it is unknown if the younger recipients is affected by donor age. We sought to evaluate the outcomes in younger heart transplant recipients from younger and older donors and conversely, the older heart transplant recipients from younger and older donors. Methods: We analyzed The United Network for Organ Sharing data registry for all adult heart transplant recipients (HTR) from 2008 to 2017. HTR with right or bi-ventricular support or TAH were excluded. Patients were stratified based on recipient age (R) 18-29, 20-39, 40-49 and >50 years old
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and donor age (D) 18-29, 20-39, 40-49 and >50 years old. Kaplan-Meier estimates were used to evaluate overall survival. Potential confounders were adjusted for, using a Cox proportional hazards model. Results: 19,514 HTR were included in the analysis. In the overall cohort of HTR, 6.22% (n=1213) were 18-29, 8.48% (n=28670 were 30-39, 15.42% (n=5877), and 69.88%were >50 years old. In the DN category 45.10% (n=8801) were 18-29, 25.90% (n=5054) were 30-39, 19.59% (n=3822) were 40-49 and 9.41% (n=1837) were >50 years old. Adjusting for other variables, the age of donor was not associated with decreased survival in R18-39. R40-49 receiving a HTX from D40-49 and D>50 had a 43% and 75 % decreased survival at 10 years, when compared to receiving from D 18-29. Similarly, R>50 receiving a HTX from D30-39, D40-49, D>50 had a 14%, 27%, and 47% decreased survival at 10 years. Cox proportional regression analysis also indicates that African American recipients, female donor to male recipient, higher BMI and previous LVAD support decrease survival. Conclusion: In a population based analysis, donor age does not appear to impact survival in younger recipients. Recipient related factors (including other co-morbidities) might potentially contribute to decreased survival in older recipients. This information can be potentially used to expand the donor organ pool.
377 Impact of Donor to Recipient Size Match on Survival after Heart Transplant Bridged with Continuous Flow Left Ventricular Assist Device R. Yanagida,1 A. Okoh,2 S. Fugar,3 M. Camacho,4 M. Strueber,4 and M.J. Zucker.2 1Newark Beth Israel Medical Center, Newark, NJ; 2Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ; 3Department of Medicine, Rush University Medical Center, Chicago, IL; and the 4 Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, Newark, NJ. Purpose: Heart transplant for patients with left ventricular assist device (LVAD) often requires long cardiopulmonary bypass and increased blood product use. Hypothesis was made that a donor heart should not be undersized so that it can tolerate complicated surgery. We evaluated the impact of donor-to-recipient size matching on outcome after heart transplantation bridged with LVAD. Methods: We reviewed UNOS registry data on patients who received heart transplant bridged with continuous flow LVAD (CF-LVAD). Patients were divided into three groups based on donor and recipient weight ratio; <0.8 (Undersized group), 0.8-1.2 (Matched group), and >1.2 (Oversized group). Pre-Transplant characteristics were compared among the groups. The primary outcome was post-transplant survival. Secondary outcomes included graft failure, dialysis requirement post-transplant and stroke. Kaplan-Meier survival curves and the log-rank test was used to predict and compare survival among 3 groups. Cox proportional hazards analysis was used to identify independent predictors of mortality. Results: From 2009 to 2015, 4020 patients were bridged to heart transplant with CF-LVAD. Undersized group included 586 patients (14.6%), Matched group included 2699 patients (67.1%) and Oversized group included 735 patients (18.3%). Incidence of post-transplant dialysis was higher in Undersized group (16%) than Matched (11.8%) or Oversized group (10%, p=0.003). Incidence of graft failure was significantly greater in Undersized group (18%) than Matched (13.4%) or Oversized group (15%, p=0.019). On univariate analysis survival of Undersized group was lower than other two groups (p=0.022). Pre-transplant serum creatinine
(p=0.001), height (0.002) and weight (p=0.007) were independent predictors of mortality but use of undersized heart was not. Conclusion: Survival of heart transplant recipients of undersized donor is lower than that of size matched or oversized donor. Pre-transplant serum creatinine, height and weight were predictors of mortality but use of undersized heart itself was not. 378 Older Donors Portend Worse Survival in Older and Younger Recipients after Heart Transplant: A UNOS Database Analysis V. Raman, O.K. Jawitz, C. White, M. Daneshmand, J. Schroder, C. Milano and M. Hartwig. Duke University Medical Center, Durham, NC. Purpose: Older donors are increasingly used in an effort to expand the donor pool in heart transplantation. We used the UNOS registry to examine the impact of older donors on the survival of recipients of different ages. Methods: The UNOS/OPTN registry (2005-2017) was interrogated for adult patients who successfully underwent an initial heart transplant without other simultaneous transplants. Donors and recipients in the highest quartile of age were labeled as older, and those below this threshold were labeled younger. Four groups of donor-recipient pairs were created: (1) younger donor and younger recipient, (2) younger donor and older recipient, (3) older donor and younger recipient, and (4) older donor and older recipient. Overall survival was analyzed using Kaplan Meier and Cox proportional hazards models. Results: A total of 23,750 patients met inclusion criteria. Donors and recipients over the age of 42 and 61 were defined as older, respectively. Older recipients were more likely to be Caucasian, have diabetes, and have malignancy. Older donors were more likely to be female, Caucasian, have a history of smoking, hypertension, and cancer, and have died from a stroke. Median survival in groups 1, 2, 3, and 4 was 13, 11, 12, and 10 years, respectively. In unadjusted and multivariable analyses, old donors were associated with worse survival compared to younger donors in both older and younger recipients (Fig. 1). Compared to group 1, group 3 (hazard ratio [HR] 1.31; 95% confidence interval [CI] 1.22, 1.40) had worse survival. Compared to group 2, group 4 (HR 1.31; 95%CI 1.24, 1.39) had worse survival. Compared to group 1, groups 3 (HR 1.35; 95%CI 1.26, 1.46), and 4 (HR 1.70; 95%CI 1.55, 1.86) had worse survival. Causes of death were similar across groups. Conclusion: Donors over the age of 42 are associated with worse survival compared to younger donors in both younger and older recipients after heart transplant. Further research is needed to optimize allocation and use of older donor organs.
379 Cardiac Allografts from Overdosed Donors: An Underutilized Resource? N.K. Ranganath,1 K.G. Phillips,1 J. Malas,1 B.E. Lonze,2 D.E. Smith,1 Z. N. Kon,1 C.G. Gidea,3 A. Reyentovich,3 and N. Moazami.1 1Cardiothoracic Surgery, NYU Langone Health, New York, NY; 2Surgery, NYU Langone Health, New York, NY; and the 3Medicine, NYU Langone Health, New York, NY.
S161 375 Time to death and graft failure Death
Height ratio Weight ratio BMI ratio LV mass ratio
Graft Failure
Odds ratio
95% CI
P-value
Odds ratio
95% CI
P-value
1.08 0.94 0.93 1.00
0.90-1.29 0.81-1.10 0.81-1.08 0.85-1.18
0.44 0.45 0.33 0.98
1.08 0.95 0.93 1.01
0.90-1.29 0.82-1.10 0.81-1.08 0.85-1.19
0.41 0.47 0.34 0.95
374 Mitigating the Impact of Gender Mismatch in Heart Transplantation Using BMI and BSA Ratios Y.D. Barac, O. Jawitz, V. Raman, M. Hartwig, J. Klapper, J. Schroder, M. Daneshmand, C. Patel and C. Milano. Duke University Medical Center, Durham, NC. Purpose: Heart transplantation is limited by the supply of donor organs. Previous studies have associated donor/recipient gender mismatch with decreased post-transplant survival and increased rates of primary graft dysfunction. We evaluate whether this risk can be mitigated. Methods: We performed a retrospective analysis of the OPTN/UNOS registry encompassing years 1987 to 2018 for all male adult recipients (>18 years) who underwent isolated heart transplantation with grafts from female donors. Comparison was made to transplants from male donors. Recipients were primarily stratified into two groups, those with BMI less than or greater than donor BMI. Patients were stratified by BSA on secondary analysis. Kaplan-Meier analysis was used to estimate survival post-transplant. Cox Proportional Hazards modeling was performed to identify independent predictors of survival. Results: A total of 8,232 candidates met inclusion criteria. Male recipients receiving hearts from higher BMI female donors were more likely to be in the ICU pre-transplant (39.5% vs 36.6%, p = 0.001), on IV inotropes at listing (35.7% vs 33.0%, p = 0.013), and were less likely to have a history of diabetes (21.4% vs 23.9%, p = 0.012). On Kaplan-Meier analysis, recipients transplanted with hearts from higher BMI female donors had improved overall survival. When stratified by BSA (Figure 1), male recipients transplanted with hearts from higher BSA female donors had similar post-transplant survival as male recipients who received hearts from male donors. On Cox Proportional Hazards analysis, increased donor BMI/BSA relative to recipient BMI/ BSA remained an independent predictor of improved survival (p < 0.05). Conclusion: Prior studies have associated transplanting hearts from female donors into male recipients with decreased post-transplant survival. In this study we have demonstrated that this may be mitigated by matching grafts from female donors to male recipients with lower BMI and especially BSA.
Characteristics and Short-Term Outcomes of Hepatitis C Antibody Positive Organs for Heart Transplantation: UNOS Analysis E.M. DeFilippis, R.C. Givens, A.R. Garan, F. Latif, S.W. Restaino, Y. Naka, K. Takeda, H. Takayama, P.C. Colombo, M.A. Farr and V.K. Topkara. Columbia University Medical Center, New York, NY. Purpose: Heart transplant centers are increasingly utilizing organs from donors infected with Hepatitis C virus (HCV). Aside from single-center experiences, there is little existing data regarding the characteristics of recipients of HCV Antibody (Ab)+ organs as well as short-term outcomes and graft survival. Methods: We analyzed the United Network for Organ Sharing registry from January 2016 and March 2018 to include adults ≥18 who had undergone heart transplantation with a HCV Ab+ donor. Information regarding nucleic acid amplification testing (NAT) was also available. Results: Between January 2016 and March 2018, 159 recipients underwent heart transplantation with HCV Ab+ donors. When comparing recipients of HCV+ to HCV- hearts, there were no differences between recipient age (53.4 vs 53.6 years, p =0.86), donor age (33.2 vs 31.9 years, p =0.055), female donor (26.0 vs 27.7%, p =0.64), body mass index (27.3 vs 27.6, p =0.47), and serum creatinine at transplant (1.4 vs 1.4, p = 0.36). There were no differences in the use of ventricular assist devices at time of transplant between groups. Recipients of HCV+ organs were more likely to be Blood Type O (55.3% vs 38.9%, p <0.001) and spent significantly fewer days as Status 1A (25.8 vs 42.6, p <0.001). Recipients of HCV+ organs had longer ischemic times (3.6 vs 3.0 hours, p <0.001) with associated longer distances from the donor hospital to the transplant center (323 vs 146 miles, p<0.001). Kaplan-Meier survival curves showed a trend towards decreased survival in the HCV+ group when compared to the HCV- group (p =0.06). Among recipients of HCV+ organs, there was no difference in survival between recipients of NAT+ and NAT- donors (Figure). Conclusion: While recipient baseline characteristics were similar between those receiving HCV+ and HCV- transplants, recipients of HCV+ organs had significantly longer ischemic times with longer distances from the donor hospital to the transplant center. Short-term survival appears similar between groups.
376 Heart Transplant Recipient and Donor Age: Should the Younger Recipient Be Matched with the Younger Donor? Y. Ravi,1 N. Srikanth,2 I.W. Paul,3 B.A. Whitson,4 S. Emani,5 and C.B. SaiSudhakar.1 1Cardiac Surgery, Scott & White, Texas A&M, Temple, TX; 2 Medical Student, Saveetha Institute of Medical Sciences, Chennai, India; 3 Medical Student, Sree Mookambika Institute of Medical Sciences, Kulasekaram, India; 4Cardiac Surgery, The Ohio State University, Columbus, OH; and the 5Internal Medicine, The Ohio State University, Columbus, OH. Purpose: With the shortage of donor hearts, older donors are being increasingly evaluated for potential recipients. Currently it is unknown if the younger recipients is affected by donor age. We sought to evaluate the outcomes in younger heart transplant recipients from younger and older donors and conversely, the older heart transplant recipients from younger and older donors. Methods: We analyzed The United Network for Organ Sharing data registry for all adult heart transplant recipients (HTR) from 2008 to 2017. HTR with right or bi-ventricular support or TAH were excluded. Patients were stratified based on recipient age (R) 18-29, 20-39, 40-49 and >50 years old
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and donor age (D) 18-29, 20-39, 40-49 and >50 years old. Kaplan-Meier estimates were used to evaluate overall survival. Potential confounders were adjusted for, using a Cox proportional hazards model. Results: 19,514 HTR were included in the analysis. In the overall cohort of HTR, 6.22% (n=1213) were 18-29, 8.48% (n=28670 were 30-39, 15.42% (n=5877), and 69.88%were >50 years old. In the DN category 45.10% (n=8801) were 18-29, 25.90% (n=5054) were 30-39, 19.59% (n=3822) were 40-49 and 9.41% (n=1837) were >50 years old. Adjusting for other variables, the age of donor was not associated with decreased survival in R18-39. R40-49 receiving a HTX from D40-49 and D>50 had a 43% and 75 % decreased survival at 10 years, when compared to receiving from D 18-29. Similarly, R>50 receiving a HTX from D30-39, D40-49, D>50 had a 14%, 27%, and 47% decreased survival at 10 years. Cox proportional regression analysis also indicates that African American recipients, female donor to male recipient, higher BMI and previous LVAD support decrease survival. Conclusion: In a population based analysis, donor age does not appear to impact survival in younger recipients. Recipient related factors (including other co-morbidities) might potentially contribute to decreased survival in older recipients. This information can be potentially used to expand the donor organ pool.
377 Impact of Donor to Recipient Size Match on Survival after Heart Transplant Bridged with Continuous Flow Left Ventricular Assist Device R. Yanagida,1 A. Okoh,2 S. Fugar,3 M. Camacho,4 M. Strueber,4 and M.J. Zucker.2 1Newark Beth Israel Medical Center, Newark, NJ; 2Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ; 3Department of Medicine, Rush University Medical Center, Chicago, IL; and the 4 Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, Newark, NJ. Purpose: Heart transplant for patients with left ventricular assist device (LVAD) often requires long cardiopulmonary bypass and increased blood product use. Hypothesis was made that a donor heart should not be undersized so that it can tolerate complicated surgery. We evaluated the impact of donor-to-recipient size matching on outcome after heart transplantation bridged with LVAD. Methods: We reviewed UNOS registry data on patients who received heart transplant bridged with continuous flow LVAD (CF-LVAD). Patients were divided into three groups based on donor and recipient weight ratio; <0.8 (Undersized group), 0.8-1.2 (Matched group), and >1.2 (Oversized group). Pre-Transplant characteristics were compared among the groups. The primary outcome was post-transplant survival. Secondary outcomes included graft failure, dialysis requirement post-transplant and stroke. Kaplan-Meier survival curves and the log-rank test was used to predict and compare survival among 3 groups. Cox proportional hazards analysis was used to identify independent predictors of mortality. Results: From 2009 to 2015, 4020 patients were bridged to heart transplant with CF-LVAD. Undersized group included 586 patients (14.6%), Matched group included 2699 patients (67.1%) and Oversized group included 735 patients (18.3%). Incidence of post-transplant dialysis was higher in Undersized group (16%) than Matched (11.8%) or Oversized group (10%, p=0.003). Incidence of graft failure was significantly greater in Undersized group (18%) than Matched (13.4%) or Oversized group (15%, p=0.019). On univariate analysis survival of Undersized group was lower than other two groups (p=0.022). Pre-transplant serum creatinine
(p=0.001), height (0.002) and weight (p=0.007) were independent predictors of mortality but use of undersized heart was not. Conclusion: Survival of heart transplant recipients of undersized donor is lower than that of size matched or oversized donor. Pre-transplant serum creatinine, height and weight were predictors of mortality but use of undersized heart itself was not. 378 Older Donors Portend Worse Survival in Older and Younger Recipients after Heart Transplant: A UNOS Database Analysis V. Raman, O.K. Jawitz, C. White, M. Daneshmand, J. Schroder, C. Milano and M. Hartwig. Duke University Medical Center, Durham, NC. Purpose: Older donors are increasingly used in an effort to expand the donor pool in heart transplantation. We used the UNOS registry to examine the impact of older donors on the survival of recipients of different ages. Methods: The UNOS/OPTN registry (2005-2017) was interrogated for adult patients who successfully underwent an initial heart transplant without other simultaneous transplants. Donors and recipients in the highest quartile of age were labeled as older, and those below this threshold were labeled younger. Four groups of donor-recipient pairs were created: (1) younger donor and younger recipient, (2) younger donor and older recipient, (3) older donor and younger recipient, and (4) older donor and older recipient. Overall survival was analyzed using Kaplan Meier and Cox proportional hazards models. Results: A total of 23,750 patients met inclusion criteria. Donors and recipients over the age of 42 and 61 were defined as older, respectively. Older recipients were more likely to be Caucasian, have diabetes, and have malignancy. Older donors were more likely to be female, Caucasian, have a history of smoking, hypertension, and cancer, and have died from a stroke. Median survival in groups 1, 2, 3, and 4 was 13, 11, 12, and 10 years, respectively. In unadjusted and multivariable analyses, old donors were associated with worse survival compared to younger donors in both older and younger recipients (Fig. 1). Compared to group 1, group 3 (hazard ratio [HR] 1.31; 95% confidence interval [CI] 1.22, 1.40) had worse survival. Compared to group 2, group 4 (HR 1.31; 95%CI 1.24, 1.39) had worse survival. Compared to group 1, groups 3 (HR 1.35; 95%CI 1.26, 1.46), and 4 (HR 1.70; 95%CI 1.55, 1.86) had worse survival. Causes of death were similar across groups. Conclusion: Donors over the age of 42 are associated with worse survival compared to younger donors in both younger and older recipients after heart transplant. Further research is needed to optimize allocation and use of older donor organs.
379 Cardiac Allografts from Overdosed Donors: An Underutilized Resource? N.K. Ranganath,1 K.G. Phillips,1 J. Malas,1 B.E. Lonze,2 D.E. Smith,1 Z. N. Kon,1 C.G. Gidea,3 A. Reyentovich,3 and N. Moazami.1 1Cardiothoracic Surgery, NYU Langone Health, New York, NY; 2Surgery, NYU Langone Health, New York, NY; and the 3Medicine, NYU Langone Health, New York, NY.