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Time-dependent prognostic effects of recipient and donor age in adult heart transplantation

Bergenfeldt, Henrik LU ; Lund, Lars H.; Stehlik, Josef; Andersson, Bodil LU ; Höglund, Peter LU and Nilsson, Johan LU (2018) In Journal of Heart and Lung Transplantation
Abstract

BACKGROUND: Recipient age and donor age are well-known prognostic factors in adult heart transplantation. However, the association between donor age and recipient age and their interaction and short- and long-term mortality is unknown. METHODS: We studied 64,354 heart transplants to adult recipients between 1988 and 2013 in the ISHLT Registry. Donor age and recipient age were analyzed as continuous and categorical variables and restricted cubic spline functions to assess non-linear associations and interactions. The end-point was all-cause mortality. RESULTS: In the multivariable analysis, the odds ratio for 30-day mortality per 10-year increase in recipient age was 1.05 (95% confidence interval [CI] 1.01 to 1.08, p = 0.009) compared... (More)

BACKGROUND: Recipient age and donor age are well-known prognostic factors in adult heart transplantation. However, the association between donor age and recipient age and their interaction and short- and long-term mortality is unknown. METHODS: We studied 64,354 heart transplants to adult recipients between 1988 and 2013 in the ISHLT Registry. Donor age and recipient age were analyzed as continuous and categorical variables and restricted cubic spline functions to assess non-linear associations and interactions. The end-point was all-cause mortality. RESULTS: In the multivariable analysis, the odds ratio for 30-day mortality per 10-year increase in recipient age was 1.05 (95% confidence interval [CI] 1.01 to 1.08, p = 0.009) compared with 1.19 (95% CI 1.15 to 1.22, p < 0.001) for donor age. In the first year, the hazard ratio for mortality was 1.05 (95% CI 1.02 to 1.07, p < 0.001) for a 10-year increase in recipient age and 1.16 (1.14 to 1.18, p < 0.001) for donor age. In Years 1 to 3, 3 to 5, and 5 to 10 post-transplant, the hazard ratio was 0.89 (95% CI 0.86 to 0.92, p < 0.001), 0.98 (95% CI 0.94 to 1.02, p = 0.266), and 1.14 (95% CI 1.11 to 1.17, p < 0.001) for recipient age, and 1.12 (95% CI 1.08 to 1.14, p < 0.001), 1.07 (95% CI 1.03 to 1.10, p < 0.001), and 1.07 (95% CI 1.05 to 1.10, p < 0.001) for donor age, respectively. There was no interaction of recipient age and donor age with survival at any follow-up time-point. CONCLUSIONS: At 30 days, both higher donor age and recipient age were associated with higher mortality. At 1 to 10 years, older donor age was associated with higher mortality at all follow-up time-points, but the hazard was greater in the short term, and recipient age was associated only with longer term mortality. The risk from donor age appears equal across recipient age groups.

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author
organization
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type
Contribution to journal
publication status
epub
subject
keywords
alternate listing, donor age, heart transplantation, primary graft dysfunction, recipient age
in
Journal of Heart and Lung Transplantation
publisher
Elsevier
external identifiers
  • scopus:85057249052
ISSN
1053-2498
DOI
10.1016/j.healun.2018.10.003
language
English
LU publication?
yes
id
53ee0a33-72d2-44c4-bad2-ccbb54b05797
date added to LUP
2018-12-04 13:12:08
date last changed
2019-01-06 14:18:33
@article{53ee0a33-72d2-44c4-bad2-ccbb54b05797,
  abstract     = {<p>BACKGROUND: Recipient age and donor age are well-known prognostic factors in adult heart transplantation. However, the association between donor age and recipient age and their interaction and short- and long-term mortality is unknown. METHODS: We studied 64,354 heart transplants to adult recipients between 1988 and 2013 in the ISHLT Registry. Donor age and recipient age were analyzed as continuous and categorical variables and restricted cubic spline functions to assess non-linear associations and interactions. The end-point was all-cause mortality. RESULTS: In the multivariable analysis, the odds ratio for 30-day mortality per 10-year increase in recipient age was 1.05 (95% confidence interval [CI] 1.01 to 1.08, p = 0.009) compared with 1.19 (95% CI 1.15 to 1.22, p &lt; 0.001) for donor age. In the first year, the hazard ratio for mortality was 1.05 (95% CI 1.02 to 1.07, p &lt; 0.001) for a 10-year increase in recipient age and 1.16 (1.14 to 1.18, p &lt; 0.001) for donor age. In Years 1 to 3, 3 to 5, and 5 to 10 post-transplant, the hazard ratio was 0.89 (95% CI 0.86 to 0.92, p &lt; 0.001), 0.98 (95% CI 0.94 to 1.02, p = 0.266), and 1.14 (95% CI 1.11 to 1.17, p &lt; 0.001) for recipient age, and 1.12 (95% CI 1.08 to 1.14, p &lt; 0.001), 1.07 (95% CI 1.03 to 1.10, p &lt; 0.001), and 1.07 (95% CI 1.05 to 1.10, p &lt; 0.001) for donor age, respectively. There was no interaction of recipient age and donor age with survival at any follow-up time-point. CONCLUSIONS: At 30 days, both higher donor age and recipient age were associated with higher mortality. At 1 to 10 years, older donor age was associated with higher mortality at all follow-up time-points, but the hazard was greater in the short term, and recipient age was associated only with longer term mortality. The risk from donor age appears equal across recipient age groups.</p>},
  author       = {Bergenfeldt, Henrik and Lund, Lars H. and Stehlik, Josef and Andersson, Bodil and Höglund, Peter and Nilsson, Johan},
  issn         = {1053-2498},
  keyword      = {alternate listing,donor age,heart transplantation,primary graft dysfunction,recipient age},
  language     = {eng},
  month        = {10},
  publisher    = {Elsevier},
  series       = {Journal of Heart and Lung Transplantation},
  title        = {Time-dependent prognostic effects of recipient and donor age in adult heart transplantation},
  url          = {http://dx.doi.org/10.1016/j.healun.2018.10.003},
  year         = {2018},
}