Twenty‐year survival following orthotopic heart transplantation in the United States. Issue 2 (8th December 2020)

• Record Type: Journal Article
• Authors: Hess, Nicholas R.; Seese, Laura M.; Mathier, Michael A.; Keebler, Mary E.; Hickey, Gavin W.; McNamara, Dennis M.; Kilic, Arman
• Is Part Of: Journal of cardiac surgery. Volume 36:Issue 2(2021)
• Page Start: 643
• Page End: 650
• Publication Date: 2020-12-08
• Subjects: clinical review -- surgical history -- transplant; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.15234
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background: This study evaluated 20‐year survival after adult orthotopic heart transplantation (OHT). Methods: The United Network of Organ Sharing Registry database was queried to study adult OHT recipients between 1987 and 1998 with over 20‐year posttransplant follow‐up. The primary and secondary outcomes were 20‐year survival and cause of death after OHT, respectively. Multivariable logistic regression was used to identify significant independent predictors of long‐term survival, and long‐term survival was compared among cohorts stratified by number of predictors using Kaplan Meier survival analysis. Results: 20, 658 patients undergoing OHT were included, with a median follow‐up of 9.0 (IQR, 3.2–15.4) years. Kaplan–Meier estimates of 10‐, 15‐, and 20‐year survival were 50.2%, 30.1%, and 17.2%, respectively. Median survival was 10.1 (IQR, 3.9–16.9) years. Increasing recipient age (>65 years), increasing donor age (>40 years), increasing recipient body mass index (>30), black race, ischemic cardiomyopathy, and longer cold ischemic time (>4 h) were adversely associated with a 20‐year survival. Of these 6 negative predictors, presence of 0 risk factors had the greatest 10‐year (59.7%) and 20‐year survival (26.2%), with decreasing survival with additional negative predictors. The most common cause of death in 20‐year survivors was renal, liver, and/or multisystem organ failure whereas graft failure more greatly impacted earlier mortality. Conclusions: This study identifies six negative preoperative predictors of 20‐year survival with 20‐year survival rates exceeding 25% in the absence of these factors. These data highlight the potential for very long‐term survival after OHT in patients with end‐stage heart failure and may be useful for patient selection and prognostication.