Outcomes of donation after brain death heart transplantation from older donors: A contemporary analysis of the UNOS database

Background: The effect of older donor age on heart transplant outcomes remains controversial, with traditional views that older donors lead to worse post-transplant survival. However, in the modern era, the use of extended donor criteria has included older donors in efforts to expand the donor pool. In this study, we examine the effects of older donor age (≥50 years) on post-transplant outcomes in donation after brain death (DBD) heart transplants in the post-allocation change era. Methods: This United Network for Organ Sharing (UNOS) database study included adult heart transplants from October 18, 2018 to June 30, 2023. We excluded circulatory death donors, prior heart and multiorgan transplants, and loss to follow-up. Propensity-matching was performed with 3:1 matching. Primary outcome was overall survival. Secondary outcomes included acute rejection, coronary vasculopathy (CAV), 30-day and 1-year mortality. Conclusion: Older donor hearts (age ≥50 years) may achieve comparable perioperative outcomes and survival with careful selection. CAD in older donors worsens overall survival, and expanded preoperative evaluation in these donors is warranted. Further investigation is required into higher rates of CAV, but this did not affect long-term graft survival.