Analysis of Heart Transplant Survival According to Difference in Age Between Donor and Recipient

•Age of heart transplant recipients is increasing because of prognostic improvements with treatments that have appeared in recent years for heart failure.•The combination of donor-recipient ages has been shown to have prognostic implications.•Donors with different age from the recipient does not seem to have an impact on long-term survival.•These results would allow to increase the donor pool because survival is not lower with donors older than the recipient. The age of heart transplant (HTx) donors and recipients is progressively increasing. The combination of donor-recipient ages has been shown to have prognostic implications. The objective of this study is to analyze survival in the first year and in the long-term based on the difference in age between donor and recipient of HTx. We performed a retrospective analysis of all consecutive HTxs performed in 1 center from 1987 to December 2021. Patients younger than 16 years, retransplants, and combined transplants were excluded. Three groups were considered according to the age of the donor and recipient: group 1: recipient and donor of the same age ± 10 years; group 2: donor >10 years older than recipient; and group 3: donor >10 years younger than recipient. A total of 841 HTxs were included (81% men, 31% urgent HTxs, donor mean (standard deviation) age 38.5 [12.3] years and recipient age 51.2 [12]). The most frequent group was group 3 with 476 patients (56%) followed by group 1 with 305 patients (36%). Figure 1 shows that long-term survival is similar in groups 1 and 2, being worse in group 3, P = .026. Mortality at the end of follow-up is 38.7% in group 1, 34.9% in group 2, and 71.9% in group 3 (P < .0001). These differences occurred in the long-term without finding significant differences the first year after HTx. No differences were found in early graft failure between the 3 groups. Using donors of a different age from the recipient does not seem to have an impact on long-term survival, except when donors are used who are more than 10 years younger than the recipient, where survival is lower. This consolidates the concept that the use of elderly donors does not affect survival, allowing the pool of donors to be expanded.