Walsh MG, Cui EY, Satija D, Gouchoe DA, Henn MC, Ganapathi AM, Whitson BA, Choi K. Increased mortality when combining older donors and recipients in heart transplantation. World J Transplant 2025; 15(4): 105974 [DOI: 10.5500/wjt.v15.i4.105974]
Corresponding Author of This Article
Kukbin Choi, MD, Assistant Professor, Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, N-825 Doan Hall, 410 W. 10th Ave, Columbus, OH 43201, United States. kukbin.choi@osumc.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Transplantation
ISSN
2220-3230
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Walsh MG, Cui EY, Satija D, Gouchoe DA, Henn MC, Ganapathi AM, Whitson BA, Choi K. Increased mortality when combining older donors and recipients in heart transplantation. World J Transplant 2025; 15(4): 105974 [DOI: 10.5500/wjt.v15.i4.105974]
World J Transplant. Dec 18, 2025; 15(4): 105974 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.105974
Increased mortality when combining older donors and recipients in heart transplantation
Martin Geard Walsh, Ervin Y Cui, Divyaam Satija, Doug A Gouchoe, Matthew C Henn, Asvin M Ganapathi, Bryan A Whitson, Kukbin Choi
Martin Geard Walsh, Divyaam Satija, Doug A Gouchoe, Matthew C Henn, Bryan A Whitson, Kukbin Choi, Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43201, United States
Ervin Y Cui, COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43201, United States
Asvin M Ganapathi, Division of Cardiac Surgery, Los Robles Regional Medical Center, Thousand Oaks, CA 91360, United States
Co-corresponding authors: Martin Geard Walsh and Kukbin Choi.
Author contributions: Walsh MG and Choi K wrote original manuscript, played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors; Walsh MG and Cui EY collected and performed formal analysis of data; Choi K, Ganapathi AM and Whitson BA determined; experimental design and rigor; Walsh MG, Satija D, Gouchoe DA, Henn MC, Ganapathi AM, Whitson BA, and Choi K validated results; all authors edited manuscript and approved of the final version of the manuscript.
Supported by The Jewel and Frank Benson Family Endowment.
Institutional review board statement: The study was deemed exempt from institutional review board (IRB: 2018H0079; approved 2/20/2018; last renewed 2/9/2024).
Informed consent statement: Given the retrospective nature of the OPTN-STAR datafile, informed consent was not applicable.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used in this study are derived from the Organ Procurement and Transplantation Network’s Standard Transplant Analysis and Research (OPTN-STAR) files. These data are not publicly available due to data use agreements and privacy regulations but may be obtained by qualified researchers through application to the United Network for Organ Sharing (UNOS). The authors do not have permission to share the dataset. Requests for access to the data may be directed to the Health Resources and Services Administration or UNOS viahttps://optn.transplant.hrsa.gov/data/request-data/.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kukbin Choi, MD, Assistant Professor, Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, N-825 Doan Hall, 410 W. 10th Ave, Columbus, OH 43201, United States. kukbin.choi@osumc.edu
Received: February 12, 2025 Revised: April 17, 2025 Accepted: July 17, 2025 Published online: December 18, 2025 Processing time: 280 Days and 9.9 Hours
Abstract
BACKGROUND
The utilization of hearts from older donors has increased, particularly for older recipients. However, the impact of older donor hearts on recipients of different ages is less known.
AIM
To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.
METHODS
The Organ Procurement and Transplant Network database was queried from 2006 to March 2024. Four groups were created stratifying by donor age (> 55 years) and recipient age (> 60 years). Kaplan-Meier curves and Cox regression models were used.
RESULTS
One thousand fifty out of 39868 transplants (2.6%) were performed utilizing hearts from older donors. The rate of older donor hearts in younger recipients was only 1.8%, while the older donor hearts were used 4.0% in older recipients (P < 0.001). Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality [hazard ratio (HR): 1.64 (95%CI: 1.42-1.90) and 1.42 (95%CI: 1.34-1.51)], while old donor/young recipient was not. Within each recipient age group, the older recipient groups showed greater differences in 1- and 5-year survival probabilities (80.4% and 67.4% with old donors, 89.2% and 76.8% with young donors) than younger recipient groups (90.3% and 77.5% with old donors, 92.2% and 80.3% with young donors).
CONCLUSION
This study demonstrates the higher utilization of older donor hearts (aged more than 55) in older recipients. Paradoxically, the combination of older donor hearts with older recipients is associated with a higher risk of mortality. However, these organs remain valuable options across all recipient age groups in current context of organ shortage.
Core Tip: Our study investigates the impact of donor and recipient age on heart transplant outcomes. We report higher mortality when older donors (> 55 years) are combined with older recipients (> 60 years) especially in the early post-operative period. Despite the increased early risk, these donors remain crucial given the organ shortage. This work highlights the need for refined selection criteria and tailored management strategies.
