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Published on: November 12, 2015
Thirty years of heart transplantation at the University Medical Centre Utrecht
A Sammani1, A M Wind2, J H Kirkels2
1Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands. a.zabihisammani-2@umcutrecht.nl.
Insights
Heart transplantation trends show shifts in patient demographics and indications over 30 years. Improved survival rates were observed, potentially due to advancements in immunosuppression and post-transplant care.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Statistics
Background:
- Heart transplantation (HTx) is a critical treatment for end-stage heart failure.
- Long-term outcomes and evolving patient/donor characteristics are crucial for optimizing HTx programs.
Purpose of the Study:
- To analyze patient demographics, indications, survival, and donor characteristics for heart transplantation over a 30-year period.
- To identify trends and changes in heart transplantation practices at the University Medical Centre Utrecht (UMCU).
Main Methods:
- Prospective data collection for all orthotopic heart transplantations in patients aged >14 years from 1985 to 2015.
- Analysis of patient demographics, indications for transplantation, donor profiles, and survival data.
Main Results:
- 489 heart transplants performed; 25% received a left ventricular assist device (LVAD) bridge to transplant.
- Shift in primary indication from ischemic heart disease to dilated cardiomyopathy since 2000.
- Increased median waiting time (40 to 513 days) and donor age (27 to 44 years); median survival estimated at 15.4 years with improved survival over time.
Conclusions:
- Significant shifts in patient/donor demographics and disease indications over 30 years.
- Increased waiting times led to greater use of LVADs as a bridge to transplant.
- Improved survival rates attributed to advancements in immunosuppressive therapy and follow-up care.
Purpose:
To analyse patient demographics, indications, survival and donor characteristics for heart transplantation (HTx) during the past 30 years at the University Medical Centre Utrecht (UMCU).
Methods:
Data have been prospectively collected for all patients who underwent HTx at the UMCU from 1985 until 2015. Patients who were included underwent orthotopic HTx at an age >14 years.
Results:
In total, 489 hearts have been transplanted since 1985; 120 patients (25%) had left ventricular assist device (LVAD) implantation prior to HTx. A shift from ischaemic heart disease to dilated cardiomyopathy has been seen as the leading indication for HTx since the year 2000. Median age at HTx was 49 years (range 16-68). Median waiting time and donor age have also increased from 40 to 513 days and from 27 to 44 years respectively (range 11-65). Donor cause of death is now primarily stroke, in contrast to head and brain injury in earlier years. Estimated median survival is 15.4 years (95% confidence interval 14.2-16.6) There is better survival throughout these years.
Conclusion:
Over the past 30 years, patient and donor demographics and underlying diseases have shifted substantially. Furthermore, the increase in waiting time due to lack of available donor hearts has led to a rise in the use of LVADs as bridge to transplant. Importantly, an improvement in survival rates is found over time which could be explained by better immunosuppressive therapy and improvements in follow-up care.
