Survival Trends Post Cardiac Transplantation: A Comparative Analysis of Irish and International Data (1985-2019)

Abstract

To determine overall survival outcomes and outcomes according to gender and era of transplantation, for cardiac transplant recipients in the Republic of Ireland and compare these against international published registry data. A retrospective registry was created of all heart transplants performed in the National Heart and Lung Transplant Centre, Dublin between 1985 and 2019. Kaplan Meier analysis and log rank comparison testing were performed for overall mortality as well as subgroup analyses. This data was then compared to international figures published annually by the ISHLT. Overall survival: Median survival was 13.27 years in comparison to 10.9 years internationally over a similar time period. Gender differences: 22.4% of transplants were in females. Median survival in males was 13.9 years and 12.07 years in females (p=0.028). Internationally, median survival was 10.7 years for males and 11.7 years for females. Decade transplanted: Median survival increased from 10.25 years for transplants performed in the 1980s to 15.03 years for those performed 2000-2009 (p=0.034) with survival curves suggesting improved survival for those transplanted after 2010. This compares favourably to ISHLT data: 10.5 years (1992-2001) and 12.4 years (2002-2008). One year survival: This increased from 69.5% for transplants performed in the 1980s, 78% for 1990-1999; 81% for 2000-2009 and 89% for 2010-2019. Conditional on survival to 1 year: Overall median survival was 16.07 years. This has increased from 12.9 years for transplants performed in the 1980s to 18.27 years for those performed 2000-2009 (p=0.069). Survival rates post cardiac transplantation in the Republic of Ireland have increased significantly from the beginning of the program in 1985 and compare favourably to international registry data. Based on data since 2000, 1 year survival is now 89%; median survival is at least 15 years and conditional on surviving to 1 year, median survival is at least 18.27 years.