Improved long-term survival in Dutch heart transplant patients despite increasing donor age: the Rotterdam experience

Over the past decades donor and recipient characteristics and medical management of heart transplantation (HT) patients have changed markedly. We studied the impact of these changes on long-term clinical outcome. Data of all consecutive HT recipients in our center have been collected prospectively. Cohort A (n = 353) was defined as the adult pts transplanted between 1984 and 1999 and was compared with cohort B (n = 227) transplanted between 2000 and 2013. Compared with cohort A, recipients in cohort B had older donors (mean age 29 vs. 43 years, donors aged >50 year: 2% vs. 33%, respectively). Survival at 1 and 10 years in cohort A vs. B was 89% vs. 86% and 53% vs. 68%, respectively (P = 0.02). Cohort B pts were treated more often with tacrolimus-based immunosuppression (77% vs. 22%; P = <0.0001) and early statins post-HT (88% vs. 18%; P = 0.0001), while renal function was better conserved at 5 and 10 years (P = 0.001 and 0.02). Multivariate analysis showed significant reduction in 10-year mortality with tacrolimus-based immunosuppression (HR 0.27 and 95% CI 0.17-0.42), hypertension post-HT (HR 0.5, 95% CI 0.36-0.72), and revascularization (HR 0.28, 95% CI 0.15-0.52). In spite of the use of much older donors, the long-term outcome after HT has improved considerably in the last decade, probably due to the introduction of newer treatment modalities.