Continuous improvement in outcome after heart transplantation — Long-term follow-up after three decades of experience. (15th March 2017)

• Record Type: Journal Article
• Authors: Dellgren, Göran; Westerlind, Andreas; Liden, Hans; Gäbel, Jakob; Bartfay, Sven-Erik; Bollano, Entela; Holmberg, Erik; Andersson, Bert; Schersten, Henrik; Karason, Kristjan
• Is Part Of: International journal of cardiology. Volume 231(2017)
• Page Start: 188
• Page End: 194
• Publication Date: 2017-03-15
• Subjects: Heart transplantation -- Mechanical circulatory support - long-term follow-up; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.12.186
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. We report on the long-term outcome after HTx at our centre and investigate trends in outcome over time. Methods: During the period, between 1984 and 2014, a total of 610 HTx procedures were performed in 595 patients (median 48 years; IQR 31–57 years; range 24 days-71 years; mean 43 years; 75% male) in our institution. Long-term outcome was investigated in the whole cohort, among children ( n = 76), bridged with mechanical circulatory support (MCS, n = 131), re-transplanted ( n = 17), and concomitant kidney transplantation ( n = 12). Results: Long-term survival was at 1, 5, 10, 15 and 20 years: 86% (95CI 0.83–0.89); 77% (95CI 0.73–0.80); 63% (95CI 0.59–0.68); 48% (95CI 0.43–0.54) and 30% (95CI 0.25–0.36), respectively. The median survival for the whole cohort was 14.1 years. Patients transplanted during the most recent time period (2010–2014) had a better survival compared to previous eras, with a 1- and 3-year survival of 94% (95CI 0.89–0.97) and 93% (95CI 0.88–0.96), respectively ( p < 0.001). However, when survival was analysed for long-term MCS ( n = 80) versus short term MCS ( n = 35), there was a significantly poorer survival for the short-term MCS group ( p = 0.001). Independent predictors of long-term mortality included recipient age ( p = 0.041); previous smoking ( p = 0.034); ischemic heart disease ( p = 0.002); and preoperative ventilator therapy ( p = 0.004). Conclusions: We have shown that continuous improvement in outcome after HTx still occurs. In the last time era, direct transplantation from short-term MCS was abandoned, which may have inflicted outcome during the last time era.