Abstract
PurposeTo analyse patient demographics, indications, survival and donor characteristics for heart transplantation (HTx) during the past 30 years at the University Medical Centre Utrecht (UMCU).MethodsData have been prospectively collected for all patients who underwent HTx at the UMCU from 1985 until 2015. Patients who were included underwent orthotopic HTx at an age >14 years.ResultsIn total, 489 hearts have been transplanted since 1985; 120 patients (25%) had left ventricular assist device (LVAD) implantation prior to HTx. A shift from ischaemic heart disease to dilated cardiomyopathy has been seen as the leading indication for HTx since the year 2000. Median age at HTx was 49 years (range 16–68). Median waiting time and donor age have also increased from 40 to 513 days and from 27 to 44 years respectively (range 11–65). Donor cause of death is now primarily stroke, in contrast to head and brain injury in earlier years. Estimated median survival is 15.4 years (95% confidence interval 14.2–16.6) There is better survival throughout these years.ConclusionOver the past 30 years, patient and donor demographics and underlying diseases have shifted substantially. Furthermore, the increase in waiting time due to lack of available donor hearts has led to a rise in the use of LVADs as bridge to transplant. Importantly, an improvement in survival rates is found over time which could be explained by better immunosuppressive therapy and improvements in follow-up care.
Highlights
Orthotopic heart transplantation (HTx) has been an effective treatment for end-stage heart failure for many years and was performed in more than 120,000 patients worldwide up until 2015 [1]
2 Department of Cardiothoracic Surgery, UMC Utrecht, Utrecht, The Netherlands vival rates is found over time which could be explained by better immunosuppressive therapy and improvements in follow-up care
In the Netherlands the first HTx was performed in Rotterdam in 1984 and in Utrecht in 1985, after a long period of decision-making by the government
Summary
Orthotopic heart transplantation (HTx) has been an effective treatment for end-stage heart failure for many years and was performed in more than 120,000 patients worldwide up until 2015 [1]. This was mainly due to improvements in diagnosis and treatment of complications such as acute rejection [3]. These improvements were led by the introduction of the calcineurin inhibitors cyclosporine in 1980, and tacrolimus several years later, and the development of the bioptome, allowing diagnostic endomyocardial biopsies for the histological diagnosis of rejection. Around 100 patients are on the national waiting list, whereas approximately 45–50 patients are transplanted each year This lack of donor hearts leads to prolonged waiting times.
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