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Risk factor analysis of orthotopic heart transplantation
Tadashi Omoto1, Kazutomo Minami, Dietmar Böthig
1Department of Thoracic and Cardiovascular Surgery, Heart Center North-Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany. omoto@kddnet.de
Insights
This study identified key factors impacting early heart transplant mortality, including recipient sex, donor age, and recipient heart disease. Long-term survival rates were also analyzed, offering insights for improving patient outcomes.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- Heart transplantation is a critical treatment for end-stage heart failure.
- Understanding risk factors for mortality is essential for improving patient outcomes.
Purpose of the Study:
- To identify independent risk factors for early mortality after heart transplantation.
- To assess long-term survival rates following heart transplantation.
- To evaluate the impact of donor and recipient characteristics on outcomes.
Main Methods:
- Retrospective analysis of 1,013 heart transplantations performed between March 1989 and December 1999.
- Univariate analysis and stepwise logistic regression for early mortality risk factors.
- Kaplan-Meier method and Cox's proportional hazards model for long-term survival analysis.
Main Results:
- Early mortality rate was 8.6%.
- Independent risk factors for early mortality included female recipients, donor age over 50 years, and recipient ischemic heart disease.
- Actuarial survival rates were 78.1% at 1 year, 69.4% at 5 years, and 53.1% at 10 years.
- Survival was better in patients with dilative cardiomyopathy compared to ischemic heart disease.
Conclusions:
- Female recipients, older donor age, and recipient ischemic heart disease are significant predictors of early mortality.
- Despite increased early mortality risk, older donor hearts should remain in the donor pool due to donor shortages.
- Long-term survival varies by recipient diagnosis, with dilative cardiomyopathy patients faring better than those with ischemic heart disease.
Abstract:
From March 1989 to December 1999, 1,013 heart transplantations were carried out in this center. Univariate analysis of potential risk factors for early death was followed by stepwise logistic regression to determine independent risk factors. Long-term results were assessed by the Kaplan-Meier method. Multivariate comparisons of long-term results were performed using Cox's proportional hazards model. Early mortality was 8.6%. Actuarial survival was 78.1%, 69.4%, and 53.1% at 1, 5, and 10 years, respectively. Mean total ischemic time was 194 minutes. Independent risk factors of early mortality were female recipient, donor age over 50 years, and ischemic heart disease in the recipient. The precise mechanism of the increased early mortality in female recipients should be studied in the future. Although older donor age was a predictor of early mortality, because of the donor shortage, older hearts should not be excluded from the donor pool. Survival was better in patients with dilative cardiomyopathy than in those with ischemic heart disease.