One Year Outcomes Following Orthotropic Heart Transplantation at a Tertiary Care Center in India

Abstract

Purpose 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 last five years at our centre and risk factors associated with early mortality. Methods A retrospective analysis of records of 40 transplant patients, performed between 2014 2019 at our center was done to calculate one-year survival and evaluate risk factors for mortality. The following risk factors were analysed for a significant correlation with mortality- infections, primary graft dysfunction (PGD), allograft rejection, ischemia time and INTER-MACS (Interagency Registry for Mechanically Assisted Circulatory Support) score. Adults who are in current follow up (n= 21 ) were interviewed for evaluation of their per capita income and quality of life and a correlation was sought with quality of life. Results The mean age of patients was 31.2 ± 1 2.7 years. The 1- year survival of patients transplanted during 2014-15 and 2016-19 was 65% and 85%, respectively. None of the risk factors studied correlated with mortality. The most common cause of death in the first year following transplant was an infection. A total ischemia time of more than 240 minutes, higher preoperative PA pressures and INTER-MACS score Conclusion The 1- year survival of patients transplanted during 2014- 15 and 2016- 19 was 65% and 85%, respectively. There was no correlation between infections, primary graft dysfunction (PGD), allograft rejection, ischemia time, INTER-MACS 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 quality of life after a heart transplant.