Influence of donor age and donor-recipient age difference on intimal hyperplasia in pediatric patients with young and adult donors vs. adult patients after heart transplantation

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2024年6月24日

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Sarah Ulrich,
Leonie Arnold,
Sebastian Michel,
Anja Tengler,
Laura Rosenthal,
Jörg Hausleiter,
Christoph S. Mueller,
Brigitte Schnabel,
Konstantin Stark,
Konstantinos Rizas,
Ulrich Grabmaier,
Julinda Mehilli,
Andre Jakob,
Marcus Fischer,
Julia Birnbaum,
Christian Hagl,
Steffen Massberg,
Nikolaus Haas,
Robert Dalla Pozza,
Madeleine Orban

摘要

Aim

Optimal selection and allocation of donor hearts is a relevant aspect in transplantation medicine. Donor age and cardiac allograft vasculopathy (CAV) affect post-transplant mortality. To what extent donor age impacts intimal hyperplasia (CAV^IH) in pediatric and adult patients after heart transplantation (HTx) is understudied.

Methods

In a cohort of 98 HTx patients, 58 pediatric (24.1% with adult donors) and 40 adult patients, we assessed the effect of donor age and donor-recipient age difference (D-R) on the continuous parameter of maximal intima thickness (mIT) in optical coherence tomography. We evaluated their predictive value regarding higher mIT and the prevalence of CAV^IH, defined as mIT > 0.3 mm, and compared it to established CAV risk factors.

Results

In the overall population, donor age correlated with mIT (p < 0.001), while in the pediatric subpopulation, both donor age and D-R correlated with mIT (p < 0.001 and p = 0.002, respectively). In the overall population, donor age was a main predictor of higher mIT and CAV^IH (p = 0.001 and p = 0.01, respectively) in addition to post-transplant interval, arterial hypertension, and dyslipidemia. In the pediatric patients, dyslipidemia remained a main predictor of both higher mIT and CAV^IH (p = 0.004 and p = 0.040, respectively), while donor age and D-R were not.

Conclusion

While there was an effect of the non-modifiable parameter of donor age regarding maximal intimal thickness, a stronger association was seen between the modifiable risk factor dyslipidemia and higher maximal intimal thickness and CAV^IH in both the overall population and the pediatric subpopulation.