Thirty-Year Dynamics of Survival Among Heart Recipients

Abstract

Introduction Russian National Research Centre of Transplantology and Artificial Organs is the leading national transplant center with 30 years’ experience of heart transplantation, which currently produces more than a half of all heart transplantations (HTx) performed in the country. Objectives The study was aimed to analyze changes in short-term and 5-year HTx outcomes during the last three decades. Methods Survival of 774 terminal heart failure patients who received with HTx in our Centre in different periods was studied. For the evaluation and comparative analysis of survival, the Kaplan-Meier method and the Cox proportional models were used. Results 800 HTx were performed in 776 patients between March 1986 and March 2017: 267 (34.3%) died, 11 (1.4%) lost from follow-up, 498 (64.3%) were alive at the end of October 2017. 25% of all deaths developed within the first week after surgery. In-hospital survival significantly improved from 0.65 ± 0.04 in 1986-2004 to 0.92 ± 0.02 in 2012-2017 (p=0.01). Five-year survival among those operated in 1986-1991, 1992-2004, 2004-2008, and 2009-2012 was 0.34 ± 0.08, 0.49 ± 0.08, 0.67 ± 0.09, and 0.85 ± 0.12, respectively (p for trend <0.05). Compared to 1986-2004, the 2012-2017 have shown significant increase in the number of HTx performed annually (5.6 ± 3.9 vs. 93.5 ± 12.0, respectively, p <0.001), recipients age (35.2 ± 11.6 vs 46.7 ± 13.7, respectively, p = 0.01), and donors age (31.3 ± 8.8 vs. 41.2 ± 11.0, respectively, p = 0.02). Conclusions Despite the more severe clinical status of recipients and expansion of the donor criteria, a significant progress of short and long-term survival was achieved as a result of the improvement in donation organization, perioperative care, immunosuppression, and patient management protocols.