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Survival analysis in heart transplantation: results from an analysis of 1290 cases in a single center

^a Department of Thoracic & Cardiovascular Surgery, Heart & Diabetes Center NRW, Bad Oeynhausen, Germany
^b Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
^c Netherlands Institutes for Health Sciences, The Netherlands

Received 10 December 2007; received in revised form 8 February 2008; accepted 11 February 2008.

^_* Corresponding author. Address: c/o Geert J.M.G. van der Heijden, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 30 250 9305; fax: +31 30 250 5485. (Email: ystjang{at}hotmail.com).

Background: The clinical profiles of recipients and donors eligible for the procedure as well as the procedure itself have changed over time. We determined the impact of changes in baseline risk profiles at different transplant periods on outcome, and the time-specific distribution of causes of death. Patients and methods: Adult heart transplantations were performed consecutively on 1290 patients. Three transplant periods were defined: 1989–1993, 1994–1998, and 1999–2004. Results: Recipient age and body mass index, previous cardiac surgery, high urgency status, need of ventricular assist device, waiting time (to transplantation and on ventricular assist device), donor age and body mass index, donor–recipient body mass index mismatch, and ischemic and cardiopulmonary bypass time were significantly different over the three transplant periods. There was, however, no significant difference in mortality risk. The major causes of deaths were: acute rejection, multiorgan failure, and right heart failure (30 days); infection and acute rejection (31 days to 1 year); malignancy, acute rejection, and cardiac allograft vasculopathy (>1–5 years); cardiac allograft vasculopathy and malignancy (>5–10 years); and malignancy and infection (>10 years). The overall 1-, 5-, 10- and 15-year survival was respectively 77%, 67%, 53% and 42%. There was no difference in survival by different transplant periods (p = 0.68). Conclusion: Despite clearly increased baseline risk profiles over time, the outcome of adult heart transplantation remains stable and encouraging. Cardiac allograft vasculopathy, malignancy, and infection threaten the long-term survival.

Key Words: Transplantation • Heart • Adult • Mortality • Survival