063: Recipients and donors profile evolution in cardiac transplantation. Single centre ten years experience

Abstract

We evaluated our 10-years experience in cardiac transplantation, taking into account the evolution of recipients and donors profiles. Between January 2000 and December 2010, 664 patients underwent isolated cardiac transplantation. Patients transplanted between 2000 and 2004 (Group I, n=243) have been compared to patients transplanted between 2005 and 2010 (Group II, n=421). The following characteristics were significantly different between the two groups: among the recipients, age, 45 years (group I) vs. 48 years (group II) p=0.01; high-emergency waiting list, 1% (group I) vs. 40% (group II), p<0.01; days on waiting list, 162 (group I) vs. 119 (group II), p=0.01; diabetes, 10% (group I) vs. 16% (group II), p=0.02; preoperative mechanical circulatory support with VAD, 20% (group I) vs. 8% (group II), p<0.01; preoperative ECMO, 0% (group I) vs. 16% (group II), p<0.01; preoperative ventilation, 2% (group I) vs. 9% (group II), p<0.01; preoperative inotropes, 11% (group I) vs. 37% (group II), p<0.01. Among the donors, age older than 60 years, 7% (group I) vs. 13% (group II), p=0.01, norepinephrine support at retrieval, 74% (group I) vs. 88% (group II), p<0.01 and ischemic time, 156 min. (group I) vs. 183 min. (group II), p<0.01. Even if the occurrence of primary graft dysfunction was the similar in both groups, 21% (group I) vs. 27% (group II), this complication was treated with high dose inotropes in 10% (group I) vs. 2% (group II), p<0.01; with ECMO in 8% (group I) vs. 25% (group II), p<0.01. One-year mortality and 5-years survival were similar in both groups: 26% (group I) vs. 29% (group II), 67% (group I) vs. 62% (group II). The evolution of waiting list criteria and perioperative use of ECMO allowed us to transplant sicker recipients, using marginal donors, without any significant impact on short and mid-term survival.