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Three decades of heart transplantation: experience and long-term outcome
Lærke Marie Nelson1, Kasper Rossing1, Søren Boesgaard1
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Heart transplantation (HTx) significantly improves long-term survival for end-stage heart failure patients. Outcomes have shown consistent improvement over three decades, highlighting HTx as a vital treatment option.
Area of Science:
- Cardiology
- Transplantation Medicine
- Clinical Outcomes Research
Background:
- Heart transplantation (HTx) is a primary treatment for end-stage heart failure.
- Long-term outcomes of HTx require continuous evaluation to assess treatment efficacy.
- Advancements in medical care necessitate updated analyses of survival trends.
Purpose of the Study:
- To evaluate the long-term outcomes of heart transplantation over three decades.
- To analyze survival trends and identify improvements in heart transplant recipients.
- To assess the impact of different eras on heart transplantation success.
Main Methods:
- Retrospective analysis of consecutive adult patients undergoing first-time, isolated heart transplantation.
- Data collected from October 1990 to November 2020 at Rigshospitalet, Copenhagen.
- Patients categorized into three eras: 1990-1999, 2000-2009, and 2010-2020.
Main Results:
- A total of 384 patients were included, with a median survival of 13.8 years.
- Survival improved numerically from the early era (12.6 years) to the mid-era (14.9 years).
- Kaplan-Meier survival probability showed significant improvement from the mid to the recent era (p=.02).
Conclusions:
- Heart transplantation remains a highly effective treatment for selected end-stage heart failure patients.
- Long-term outcomes following heart transplantation have demonstrated significant improvement over recent decades.
- Continuous monitoring and analysis of HTx outcomes are crucial for advancing patient care.
Abstract:
Objectives. Heart transplantation (HTx) has become an established treatment option in patients with end-stage heart failure. The aim of this study was to report on long-term outcome over the past three decades. Design. Consecutive adult patients receiving first-time and isolated HTx from October 3, 1990, to November 2, 2020, at Rigshospitalet, Copenhagen, Denmark, were retrospectively evaluated. Data were obtained from the Scandinavian Transplant Registry and patient medical records. Recipients were grouped by time of transplantation (early era: 1990-1999; mid era: 2000-2009; recent era: 2010-2020). Results. A total of 384 recipients (77% men, median age 50 [IQR: 40-57]) were included. Median number of HTx procedures per year was 12 (10-14). Overall, 22% of patients were bridged to HTx with a mechanical circulatory support device. Median survival for the whole cohort was 13.8 years and improved numerically from the early era (12.6 years) to the mid era (14.9 years). Median survival conditional on survival to 1-year follow-up after HTx was 16.1 years. Survival probability by Kaplan-Meier method improved significantly from the mid to the recent era (log-rank p = .02). Conclusions. Heart transplantation remains an excellent treatment for selected patients with end-stage heart failure and long-term outcome has improved significantly over the past decades.
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