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The Korean Organ Transplant Registry (KOTRY): Third Official Adult Heart Transplant Report
Hyo-In Choi1, Sang Eun Lee2, Junho Hyun3
1Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
This study analyzed 709 adult heart transplants (HT) in Korea, revealing increased mechanical circulatory support (MCS) use before HT. Outcomes were impacted by donor factors, recipient age, and rejection risk, highlighting evolving HT practices.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- The Korean Organ Transplant Registry (KOTRY) presents its third report on adult heart transplantation (HT).
- Data encompasses 709 adult recipients from seven major Korean centers (March 2014 - December 2020).
Purpose of the Study:
- To analyze trends in adult heart transplant recipients and donors.
- To evaluate the impact of various factors on post-transplant outcomes.
- To assess the evolving role of mechanical circulatory support (MCS) in heart transplantation.
Main Methods:
- Retrospective analysis of KOTRY data from adult heart transplants.
- Focus on immunosuppression, acute rejection, cardiac allograft vasculopathy (CAV), survival, and MCS usage.
- Multivariate analysis to identify risk factors for mortality and adverse outcomes.
Main Results:
- Median recipient age was 56, donor age 43; common indications were cardiomyopathy and ischemic heart disease.
- Increased use of left ventricular assist device (LVAD) as bridge-to-transplant (2.17% to 22.4%).
- Risk factors for mortality included predicted heart mass mismatch and age >70; CAV risk increased with male and older donors (>45). Acute rejection linked to high PRA (>80%), statin use reduced risk. Pre-transplant ECMO associated with worse survival.
Conclusions:
- The third KOTRY report highlights significant shifts in adult heart transplantation demographics and practices.
- Increased utilization of MCS prior to HT is a key trend impacting post-transplant outcomes.
- Recipient and donor characteristics, alongside immunological factors, continue to influence long-term success in heart transplantation.
Background And Objectives:
The Korean Organ Transplant Registry (KOTRY) provided data for this third official report on adult heart transplantation (HT), including information from 709 recipients.
Methods:
Data from HTs performed at seven major centers in Korea between March 2014 and December 2020 were analyzed, focusing on immunosuppression, acute rejection, cardiac allograft vasculopathy (CAV), post-transplant survival, and mechanical circulatory support (MCS) usage.
Results:
The median ages of the recipients and donors were 56.0 and 43.0 years, respectively. Cardiomyopathy and ischemic heart disease were the most common preceding conditions for HT. A significant portion of patients underwent HT at waiting list status 1 and 0. In the multivariate analysis, a predicted heart mass mismatch was associated with a higher risk of 1-year mortality. Patients over 70 years old had a significantly increased risk of 6-year mortality. The risk of CAV was higher for male donors and donors older than 45 years. Acute rejection was more likely in patients with panel reactive antibody levels above 80%, while statin use was associated with a reduced risk. The employment of left ventricular assist device as a bridge to transplantation increased from 2.17% to 22.4%. Pre-transplant extra-corporeal membrane oxygenation was associated with worse post-transplant survival.
Conclusions:
In this third KOTRY report, we analyzed changes in the characteristics of adult HT recipients and donors and their impact on post-transplant outcomes. The most notable discovery was the increased use of MCS before HT and their impact on post-transplant outcomes.
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