Continuous improvement in outcome after heart transplantation — Long-term follow-up after three decades of experience

• Published in: International journal of cardiology 2017-03, Vol.231, p.188-194
• Main Authors: Dellgren, Göran, Westerlind, Andreas, Liden, Hans, Gäbel, Jakob, Bartfay, Sven-Erik, Bollano, Entela, Holmberg, Erik, Andersson, Bert, Schersten, Henrik, Karason, Kristjan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cardiac and Cardiovascular Systems; Cardiovascular; Child; Child, Preschool; Female; Follow-Up Studies; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Heart Transplantation; Humans; Incidence; Infant; Infant, Newborn; Kardiologi; Male; Mechanical circulatory support - long-term follow-up; Middle Aged; Postoperative Period; Prognosis; Retrospective Studies; Survival Rate - trends; Sweden - epidemiology; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2016.12.186

Abstract Aims Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. We report on the long-term outcome after HTx at our centre and investigate trends in outcome over time. Methods During the period, between 1984 and 2014, a total of 610 HTx procedures were performed in 595 patients (median 48 years; IQR 31–57 years; range 24 days-71 years; mean 43 years; 75% male) in our institution. Long-term outcome was investigated in the whole cohort, among children ( n = 76), bridged with mechanical circulatory support (MCS, n = 131), re-transplanted ( n = 17), and concomitant kidney transplantation ( n = 12). Results Long-term survival was at 1, 5, 10, 15 and 20 years: 86% (95CI 0.83–0.89); 77% (95CI 0.73–0.80); 63% (95CI 0.59–0.68); 48% (95CI 0.43–0.54) and 30% (95CI 0.25–0.36), respectively. The median survival for the whole cohort was 14.1 years. Patients transplanted during the most recent time period (2010–2014) had a better survival compared to previous eras, with a 1- and 3-year survival of 94% (95CI 0.89–0.97) and 93% (95CI 0.88–0.96), respectively ( p < 0.001). However, when survival was analysed for long-term MCS ( n = 80) versus short term MCS ( n = 35), there was a significantly poorer survival for the short-term MCS group ( p = 0.001). Independent predictors of long-term mortality included recipient age ( p = 0.041); previous smoking ( p = 0.034); ischemic heart disease ( p = 0.002); and preoperative ventilator therapy ( p = 0.004). Conclusions We have shown that continuous improvement in outcome after HTx still occurs. In the last time era, direct transplantation from short-term MCS was abandoned, which may have inflicted outcome during the last time era.