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J Thorac Cardiovasc Surg 2007;133:554-559
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

The effect of ischemic time on survival after heart transplantation varies by donor age: An analysis of the United Network for Organ Sharing database

^a Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York
^b International Center for Health Outcomes and Innovation Research, Columbia University, New York
^c Division of Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York
^d Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York

Received for publication February 22, 2006; revisions received July 3, 2006; accepted for publication September 7, 2006.

^_* Reprint requests: Yoshifumi Naka, MD, PhD, Division of Cardiothoracic Surgery, New York-Presbyterian Hospital/Columbia, Milstein Hospital Bldg Room 7-435, 177 Fort Washington Avenue, New York, NY 10032. (Email: yn33{at}columbia.edu).

OBJECTIVES: (1) To examine the interaction of donor age with ischemic time and their effect on survival and (2) to define ranges of ischemic time associated with differences in survival.

METHODS: The United Network for Organ Sharing provided de-identified patient-level data. The study population included 33,640 recipients undergoing heart transplantation between October 1, 1987, and December 31, 2004. Recipients were divided by donor age into terciles: 0 to 19 years (n = 10,814; 32.1%), 20 to 33 years (11,410, 33.9%), and 34 years or more (11,416, 33.9%). Kaplan-Meier survival functions and Cox regression were used for time-to-event analysis. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 5-year survival at various thresholds for ischemic time.

RESULTS: In univariate Cox proportional hazards regression, the effect of ischemic time on survival varied by donor age tercile: 0 to 19 years (P = .141), 20 to 33 years (P < .001), and 34 years or more (P < .001). These relationships persisted in multivariable regression. Threshold analysis generated a single stratum (0.37-12.00 hours) in the 0- to 19-year-old group with a median survival of 11.4 years. However, in the 20- to 33-year-old-group, 3 strata were generated: 0.00 to 3.49 hours (limited), 3.50 to 6.24 hours (prolonged), and 6.25 hours or more (extended), with median survivals of 10.6, 9.9, and 7.3 years, respectively. Likewise, 3 strata were generated in the group aged 34 years or more: 0.00 to 3.49 (limited), 3.50 to 5.49 (prolonged), and 5.50 or more (extended), with median survivals of 9.1, 8.5, and 6.3 years, respectively.

CONCLUSIONS: The effect of ischemic time on survival after heart transplantation is dependent on donor age, with greater tolerance for prolonged ischemic times among grafts from younger donors. Both donor age and anticipated ischemic time must be considered when assessing a potential donor.

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