One year outcomes following orthotopic heart transplantation at a tertiary care center in India

Abstract

Introduction: Cardiac transplantation remains the gold standard for end stage heart failure. Even after 25 years, the progress of heart transplants in India has not been as expected, especially in the public sector. Till recently, ours was the only government hospital in India with a successfully running heart transplant program. This study's primary objective was to evaluate the 1-year survival of heart recipients in the past 5 years at our center and risk factors associated with early mortality. The secondary objective was to assess the correlation between per capita income and quality of life (QOL). Methodology: A retrospective analysis of records of 40 transplant patients, performed between June 2014 and June 2019 at our center, was done to calculate 1-year survival and evaluate risk factors for mortality. The following risk factors were analyzed for a significant correlation with mortality-infections, primary graft dysfunction (PGD), allograft rejection, ischemia time, and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score. Adults (>18 years of age) who are in the current follow-up (n = 21) were interviewed for the evaluation of their per capita income and QOL. A correlation was sought for between per capita income and QOL. Results: The mean age of patients was 31.2 ± 12.7 years. The 1-year survival of patients transplanted during 2014–2015 and 2016–2019 was 65% and 85%, respectively. None of the risk factors studied correlated with mortality. The most common cause of death in the 1st year following transplant was an infection. A total ischemia time of more than 240 min, higher preoperative PA pressures, and INTERMACS score ≤2 are significant risk factors for developing PGD. The mean monthly per capita income of the 21 patients, interviewed for QOL, is ₹7142 ± 3050. The cost of heart transplant for the first 2 years (including surgical expenses) is ₹997,760 ± 104,751 rupees at our institute, and the current mean monthly spending for medicines is ₹15,214 ± 5041. Conclusion: The 1-year survival of patients transplanted during 2014–2015 and 2016–2019 was 65% and 85%, respectively. There was no correlation between infections, PGD, allograft rejection, ischemia time, INTERMACS score, and mortality. The QOL of heart recipients, from economically weaker sections, is similar to that of India's general population. There is no correlation between per capita income and QOL after a heart transplant.