Survival in Adult Patients Undergoing Heart Transplantation 1995-2024: A Report of the RETRAC Registry

Heart transplantation (HT) remains the definitive treatment for advanced heart failure that is refractory to both medical and invasive therapies. Although global registries offer extensive data on survival outcomes, there is a relative paucity of information regarding HT outcomes in Latin America (LATAM), particularly in Colombia.

This study analyzed adult patients who underwent HT between 1995 and 2024, using data obtained from an institutional HT registry (RETRAC) in Cali, Colombia. Survival outcomes were evaluated using Kaplan-Meier curves and Cox proportional hazards models.

We included 260 patients who underwent HT in this 29-year cohort from a LATAM country. The median age at transplantation was 51 years, and 77.7% were male. The primary etiologies were idiopathic/dilated cardiomyopathy (IDC) (41.3%), ischemic cardiomyopathy (IC) (27.0%), and valvular heart disease (VHC) (9.7%). The most prevalent comorbidities were hypertension (HTN) (48.3%), diabetes mellitus (DM) (18.9%), and chronic kidney disease (CKD) (13.1%). The overall median survival following HT was 7.4 years. One-year survival was 74.6% (n = 194), five-year survival was 56.9% (n = 147), and ten-year survival was 46.9% (n = 122). Survival differed significantly by age and sex, with patients aged <40 years demonstrating the highest median survival (8.4 years) and those aged ≥60 years the lowest (2.2 years) (p = 0.038). The 40- to 49-year age group exhibited the most pronounced reduction in survival; however, this effect was attenuated after adjustment. Among patients under 40 years, females had significantly higher mortality compared to males (p = 0.0078), with younger males exhibiting better survival. Additionally, patients transplanted between 2016 and 2020 had higher survival rates. CKD was identified as a significant independent risk factor for increased mortality (hazard ratio (HR) = 1.79; 95% CI: 1.15-2.79; p = 0.01).

HT patients in Colombia exhibit demographic and clinical profiles comparable to global cohorts; however, they demonstrate lower survival rates and poorer clinical outcomes compared to international registries, such as the International Society for Heart and Lung Transplantation registry. Nonetheless, clinical outcomes are more favorable than those reported in other studies from the LATAM region. CKD emerged as a significant independent predictor of mortality. These findings highlight the need for region-specific strategies aimed at improving HT outcomes in LATAM.