RECIPIENT PROFILE AND OUTCOMES OVER 30 YEARS OF A SINGLE QUATERNARY HOSPITAL'S HEART TRANSPLANT PROGRAM

Abstract

Cardiac transplantation remains the standard of care for eligible patients with advanced heart failure. This study reports on 30 years of experience in a single quaternary hospital with an analysis of recipient profile and outcomes. We performed a retrospective analysis between 1985 and 2016 and compared recipient profile and outcomes between the heart transplant program’s 3 decades. Retransplantation patients were excluded. From 1985-2016, 650 patients were transplanted; mean recipient age (49±11 years) did not differ significantly between the different decades; overall 44% were blood group type A, 27% were Caucasian and 69% were male patients. From the first to the last decade, non-ischemic myopathies and congenital etiologies increased from 27 to 58% and 1 to 10%, respectively. Ischemic cardiomyopathies decreased from 63 to 22% over time (p<0.001). There was a significant increase in the number of diagnosed rejection episodes between the 1st and 2nd decades; however, this decreased during the most recent decade (1st 1.0±2.4, 2nd 4.6±5, 3rd 3.5±3.1; p<0.001). Reduced infection episodes and cases of malignancy were also noted in the last decade (p<0.001). The number of patients listed as status 3 or higher in the last decade significantly increased compared to the 2nd decade (Chi-square, p<0.001). Additionally, the number of patients bridged with left-ventricular assist devices (LVAD) significantly increased from the beginning of the institution’s LVAD program in 2000 (p<0.001). There was also a significant increase in cold ischemic time over the decades (p=0.010). Patient cause of death did not differ significantly across decades, with graft failure (23.7%) and infections (14%) accounting for most cases. Patient survival progressively improved between the 3 decades (5-year survival: 1st 66%, 2nd 76%, 3rd 86%, 10-year survival: 1st 46%, 2nd 67%, 3rd 73%; Log rank test, p<0.001). We have described the recipient profile and outcomes over three decades from a single tertiary hospital’s heart transplantation program. An improvement in survival has been noted despite increasingly complex cases and a higher recipient risk profile being accepted for transplantation. Improvements in peri- and post-operative patient care may have led to decreased episodes of rejection and infectious diseases, improving patient outcomes.