Evolving practice patterns in heart transplantation: a single-center experience over 15 years

Area of Science:

• Cardiology
• Transplantation Medicine
• Immunology

Background:

• Heart transplantation outcomes have evolved over time.
• Donor and recipient factors significantly influence transplant success.
• Understanding these factors is crucial for improving patient survival and graft function.

Purpose of the Study:

• To analyze evolving donor and recipient risk factors impacting heart transplant outcomes.
• To evaluate determinants of hospital and 1-year mortality.
• To compare outcomes between two distinct 15-year eras of heart transplantation.

Main Methods:

• Retrospective analysis of heart transplant procedures from 1988-2003.
• Comparison of patient and donor characteristics between two eras (1988-1995 vs. 1996-2003).
• Evaluation of pretransplant diagnosis, UNOS status, donor age, ischemic time, size match, and myocardial necrosis.

Main Results:

• The later era (1996-2003) utilized more marginal donors and accepted sicker recipients (higher UNOS status, PVR).
• Despite these challenges, the later era showed significantly lower hospital mortality (10.6% vs. 18.1%) and improved 1- and 5-year survival.
• Fatal events due to graft failure and acute rejection were reduced, though freedom from acute rejection remained similar.

Conclusions:

• Improved global management strategies led to better heart transplant outcomes, even with increased use of marginal donors and compromised recipients.
• Key determinants of hospital mortality included pretransplant diagnosis, UNOS status, donor age, and cardioplegic solution.
• Transplant era, recipient age, infections, and myocardial necrosis were risk factors for 1-year mortality.