Extended Criteria Donor Use in Heart Transplantation: A Promising Strategy to Expand the Donor Pool

<b>Background</b>: To address organ shortage and reduce waitlist mortality, the use of extended criteria donors (ECDs) in heart transplantation is increasing. <b>Methods</b>: We retrospectively analysed outcomes in 236 heart transplant recipients: 140 received standard donor (SD) hearts and 96 received ECD hearts. <b>Results</b>: No significant differences were found in early or mid-term survival between the SD and ECD groups with a 30-day mortality rates of 13% vs. 10% (<i>p</i> = 0.662) and estimated 1-year survival of 75% (95% CI: 62.3-78.3%) and 71% (95% CI: 55.3-76.2%) (<i>p</i> = 0.556), respectively. Mechanical ventilation prior to transplant (<i>p</i> < 0.001), ischemic time (<i>p</i> = 0.022), peripheral vascular disease (<i>p</i> = 0.011), and chronic obstructive pulmonary disease (<i>p</i> = 0.022) were the only independent predictors of mortality. <b>Conclusions</b>: In our cohort, heart transplantation using ECD was not associated with increased early or mid-term adverse events. This approach may help expand the donor pool without compromising post-transplant outcomes.