Heart transplantation in the 21st century in Netherlands: Improved survival in the last decade

Objective Over the past decades donor and recipient characteristics and medical management of heart transplantations patients have changed markedly. We studied the impact of these changes on longterm clinical outcome. Design and methods Data of all consecutive heart transplant recipients in our center have been collected prospectively. Cohort A (n = 353 patients) was defined as the patients transplanted between 1984 and 1999, and was compared with cohort B (n = 227 patients) transplanted between 2000 and 2013. Results Compared to cohort A, recipients in cohort B had older donors (mean age 29 vs. 43 years, donors aged > 50 year: 2% vs. 33%, respectively). Oneyear survival in cohort A vs. B was 89% vs. 86% and at 10 years 53% vs. 68%, respectively (p = 0.02). Cohort B patients were treated more often with tacrolimus based immunosuppression (77% vs. 22%; p < 0.001), and early statins postheart transplantation (88% vs. 18%; p = 0.001), while renal function was better conserved at 5 and 10 years (p = 0.001 and 0.02). Multivariate analysis showed significant reduction in 10 years mortality with tacrolimusbased immunosuppression (HR: 0.27 and 95% CI 0.170.42), treatment of hypertension (HR: 0.5, 95% CI 0.360.72) and revascularization (HR: 0.28, 95% CI 0.150.52). Conclusion In spite of the use of much older donors, the longterm outcome after heart transplantation has improved considerably in the last decade, probably due to the introduction of newer treatment modalities.