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Published on: October 12, 2014
Survival Analysis in Adult Heart Transplantation: Experience from a Brazilian Single Center
Diogo Luiz de Magalhães Ferraz1, Cristiano Berardo Carneiro da Cunha1,2, Fernando Augusto Marinho Dos Santos Figueira1
1Department of Cardiovascular Surgery, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil.
Insights
Heart transplant survival rates improved significantly over time in Brazil. Key factors for early mortality include longer bypass times and donor characteristics, while increased volume and experience enhance outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- Heart transplantation is the definitive treatment for end-stage heart failure.
- This study focuses on survival rates and early mortality risk factors in Brazilian adult heart transplant recipients.
Purpose of the Study:
- To analyze survival trends in heart transplant recipients over distinct time periods.
- To identify critical risk factors associated with 30-day mortality post-heart transplantation.
Main Methods:
- Retrospective cohort study of 255 adult heart transplant patients in Brazil.
- Data collected from medical records across three periods: 2012-2015, 2016-2019, and 2020-2022.
- Statistical analysis included Kaplan-Meier curves, Cox regression for mortality risk, and Log-rank tests.
Main Results:
- Overall 1-year survival was 68.1%, 5-year was 58%, and 10-year was 40.8%.
- Survival improved in later periods (2016-2022), with 1-year survival at 73.2% and 5-year at 63%.
- Risk factors for 30-day mortality included prolonged cardiopulmonary bypass, earlier transplant period, older donor age, and donor overweight/obesity. Primary causes of early death were infection and graft dysfunction.
Conclusions:
- Improved surgical volume, enhanced team expertise, and updated immunosuppression protocols have led to better early and mid-term outcomes.
- Continuous quality improvement is vital for optimizing heart transplant success rates.
Introduction:
Heart transplantation is the gold standard for advanced heart failure treatment. This study examines the survival rates and risk factors for early mortality in adult heart transplant recipients at a Brazilian center.
Methods:
This retrospective cohort study involved 255 adult heart transplant patients from a single center in Brazil. Data were collected from medical records and databases including three defined periods (2012-2015, 2016-2019, and 2020-2022). Statistical analysis employed Kaplan-Meier survival curves, Cox proportional hazards analysis for 30-day mortality risk factors, and Log-rank tests.
Results:
The recipients were mostly male (74.9%), and the mean age was 46.6 years. Main causes of heart failure were idiopathic dilated cardiomyopathy (33.9%), Chagas cardiomyopathy (18%), and ischemic cardiomyopathy (14.3%). The study revealed an overall survival of 68.1% at one year, 58% at five years, and 40.8% at 10 years after heart transplantation. Survivalimproved significantly over time, combining the most recent periods (2016 to 2022) it was 73.2% in the first year and 63% in five years. The main risk factors for 30-day mortality were longer time on cardiopulmonary bypass, the initial period of transplants (2012 to 2015), older age of the donor, and nutritional status of the donor (overweight or obese). The main causes of death within 30 days post-transplant were infection and primary graft dysfunction.
Conclusion:
The survival analysis by period demonstrated that the increased surgical volume, coupled with the team's experience and modifications to the immunosuppression protocol, contributed to the improved early and mid-term outcomes.
