Improved long-term survival in Dutch heart transplant patients despite increasing donor age: The Rotterdam experience
Transplant International , Volume 28 - Issue 8 p. 962- 971
Over the past decades donor and recipient characteristics and medical management of heart transplantation (HT) patients have changed markedly. We studied the impact of these changes on long-term clinical outcome. Data of all consecutive HT recipients in our center have been collected prospectively. Cohort A (n = 353) was defined as the adult pts transplanted between 1984 and 1999 and was compared with cohort B (n = 227) transplanted between 2000 and 2013. Compared with cohort A, recipients in cohort B had older donors (mean age 29 vs. 43 years, donors aged >50 year: 2% vs. 33%, respectively). Survival at 1 and 10 years in cohort A vs. B was 89% vs. 86% and 53% vs. 68%, respectively (P = 0.02). Cohort B pts were treated more often with tacrolimus-based immunosuppression (77% vs. 22%; P = <0.0001) and early statins post-HT (88% vs. 18%; P = 0.0001), while renal function was better conserved at 5 and 10 years (P = 0.001 and 0.02). Multivariate analysis showed significant reduction in 10-year mortality with tacrolimus-based immunosuppression (HR 0.27 and 95% CI 0.17-0.42), hypertension post-HT (HR 0.5, 95% CI 0.36-0.72), and revascularization (HR 0.28, 95% CI 0.15-0.52). In spite of the use of much older donors, the long-term outcome after HT has improved considerably in the last decade, probably due to the introduction of newer treatment modalities.
|heart transplantation, older donors, prognosis, survival|
|Organisation||Department of Cardiology|
Zijlstra, L.E, Constantinescu, A.A, Manintveld, O.C, Birim, O, Hesselink, D.A, van Thiel, R.J, … Caliskan, K.C. (2015). Improved long-term survival in Dutch heart transplant patients despite increasing donor age: The Rotterdam experience. Transplant International, 28(8), 962–971. doi:10.1111/tri.12503