Increasing Donor Age on the Risk of Permanent Pacing After Or­tho­­topic Heart Transplantation

K. Caliskan, F. Akca, A.A. Constantinescu, O.C. Manintveld, S. Akin, O. Birim, T. Szili-Torok

Chair(s): dr. Marije C. Baas, nefroloog, Radboudumc, Nijmegen & dr. Dries E. Braat, chirurg, LUMC

Thursday 10 march 2016

14:20 - 14:30h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie XII - Klinisch

Background:
Due to scarcity of donor hearts, older and marginal donors are accepted for orthotopic heart transplantation (HTx). We evaluated the relationship between donor age and need for pacemaker (PM) implantation after HTx.

Methods:
Patients transplanted between 1984 until 2014 were analysed (n=612, 74% male; median follow up of 99 months [IQR 40-166]). Three groups were created based on donor age: Group I (0–35 y, n=345), Group II (35–50 y, n=190) and Group III (>50 y, n=77). The primary outcome was PM implantation after HTx for sinus node dysfunction (SND) or AV block (AVB). The need for early (90 days) was evaluated.

Results:
The mean recipient age at HTx was 46.4±14.3 years [range 2-72 y]. Significant older donor hearts were transplanted during the last 10 years compared to the first 10 years (40.1±15.9 y vs. 25.7±8.3 y, p<0.001) and more early PM's were implanted (10.2% vs. 1.7%, p<0.001). Ischemic time (176±45 min vs. 181±48 min vs. 186±48 min, p=ns, respectively) was comparable for group I, II and III. Overall 11.6% (SND, n=26; AVB, n=45) received a PM after a median period of 13 months [IQR 1.3–97 months]. In group III a higher amount of early PM were implanted (11.7%, n=9) compared to group I (2.0%, n=7; p=0.001). For late PM implant equal rates were observed (6.5% vs. 7.2%, p=ns, respectively).

Conclusion:
Increasing donor age, particularly >50 years, is a major risk factor for the need of permanent pacing post-HTx.