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Current outcome of heart transplantation: a 10-year single centre perspective and review
I M Hamour1, A Khaghani, P K Kanagala
1The Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK.
Insights
Heart transplantation (HTx) offers good survival for advanced heart failure patients. However, long-term concerns include malignancy and chronic kidney disease (CKD) despite lower allograft vasculopathy rates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation (HTx) is a critical treatment for end-stage heart failure.
- Donor organ scarcity necessitates evaluating outcomes of current HTx protocols.
- Advancements in immunosuppressive and adjunctive therapies are improving HTx efficacy.
Purpose of the Study:
- To assess the long-term outcomes of heart transplantation.
- To evaluate patient survival rates and graft function post-HTx.
- To identify the incidence of major complications, including allograft vasculopathy, malignancy, and chronic kidney disease (CKD).
Main Methods:
- Analysis of 399 consecutive heart transplant recipients from 1995-2007.
- Inclusion of patients requiring mechanical circulatory support prior to HTx.
- Longitudinal follow-up to assess survival, graft status, and adverse events.
Main Results:
- Actuarial survival reached 62% at 10 years, irrespective of pre-transplant heart failure severity.
- Allograft vasculopathy incidence was 23% by 10 years; graft function remained preserved (LVEF ~74%).
- 10-year cumulative incidence of malignancy was 27%, and CKD was 72%, with 10.6% requiring renal replacement therapy.
Conclusions:
- HTx provides effective medium-term survival for advanced heart failure.
- While allograft vasculopathy is less frequent than previously reported, malignancy and CKD pose significant long-term challenges.
- Ongoing monitoring and management strategies are crucial for improving long-term HTx patient outcomes.
Background:
Heart transplantation (HTx), the gold standard therapy for advanced heart failure, is limited by donor availability; alternative therapies are now becoming available.
Aim:
We examined the outcome of HTx with current immunosuppressive and adjunctive therapy.
Design And Methods:
We analysed the outcome of 399 consecutive patients who underwent transplantation at our centre (1995-2007). Prior to HTx 23% (98) required inotropic support, 8.5% (34) an intra-aortic balloon pump and 11% (43) a ventricular assist device.
Results:
Actuarial patient survival was 86% at 30 days, 79% at 1 year and 62% at 10 years. Survival was similar regardless of the heart failure severity, P=0.22. The cumulative incidence of allograft vasculopathy, Costanzo grade≥2, was 7% at 5 years and 23% by 10 years with an 11% cumulative probability of requiring a percutaneous coronary intervention by 10 years. Allograft function was preserved with a mean±SD left ventricular ejection fraction of 73±7% at 1 year and 74±8% at 10 years. The cumulative incidence of malignancy by 10 years was 27% (skin malignancy 13% and post transplant lymphoproliferative diseases 10%). The cumulative incidence of developing chronic kidney disease (CKD) with an estimated glomerular filtration rate≤45 ml/min/1.73 m2 was 42% at 1 year, 62% at 5 years and 72% at 10 years and of requiring long-term renal replacement therapy was 10.6% at 10 years.
Conclusion:
HTx provided good medium-term survival for patients with advanced heart failure, independent of its severity. The incidence of allograft vasculopathy was lower than reported previously but malignancy and CKD remain cause for concern.
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