Changing patterns in donor and recipient risk: A 10-year evolution in one heart transplant center

Background: Expansion of the donor pool and liberalization of recipient criteria have occurred since the introduction of cyclosporine for heart transplantation. Methods: We sought to evaluate the impact of these changes on outcome during a 10-year period in one program. A total of 251 transplantations were retrospectively reviewed and divided into two periods (1984 to 1989 and 1990 to 1994). Results: In the latter period, there were increases in donor and recipient age, degree of weight mismatch, ischemic time, bypass time, and severity of illness in the recipient before transplantation as judged by status at the time of transplantation and preoperative requirements for pharmacologic or mechanical support. Despite these changes time to hospital discharge decreased and a trend to improved survival was seen with the use of Kaplan-Meier analysis. Conclusions: These findings suggest that improvements in perioperative and posttransplantation care have permitted a safe expansion of both the donor pool and recipient criteria for transplantation.