RISK-FACTORS FOR DEATH AFTER HEART-TRANSPLANTATION - DOES A SINGLE-CENTER EXPERIENCE CORRELATE WITH MULTICENTER REGISTRIES

Background. Risk factors for death after heart transplantation (Tx) ar e frequently documented from multicenter registries. Although this inf ormation is helpful, it reflects a whole range of experiences and resu lts, and may not translate to a particular center. This study was perf ormed to (1) evaluate pre-Tx factors affecting mortality in a single-c enter experience, and (2) compare these factors with risk factors obta ined from multicenter registry reports. Methods. Review of our transpl ant database between January 1984 and December 1995 identified 405 adu lts who received a primary heart Tx. Multiple factors were analyzed, i ncluding demographics, Tx era, cytomegalovirus status, United Network for Organ Sharing status of recipient, presence of pulmonary hypertens ion, previous cardiac operations, mechanical ventilation or circulator y support, ischemia time, number of rejection episodes, and preoperati ve now cytometry crossmatching. Results. One- and 5-year survival rate s were 87.8% and 73.4%, respectively (Kaplan-Meier). Contrary to multi center registry reports, our data indicate that reoperative procedures , left ventricular assist device support, increasing donor and recipie nt age, and ischemia time up to 4.2 hours are not risk factors for dea th after Tx. Likewise, mode of donor death is not a risk factor affect ing outcome. Significant risk factors for mortality identified by mult ivariate analysis included early transplant era (1984 to 1989; p = 0.0 02), female donor (p = 0.042), cytomegalovirus-seropositive donor (p = 0.048), high pulmonary vascular resistance (p = 0.018), and intraaort ic balloon pump support (p = 0.03). It also identified a positive B-ce ll flow cytometry crossmatch (p = 0.015) to be a risk factor with univ ariate analysis. Conclusions. Our data identify a group of recipients, reportedly at high risk in multicenter registries, who are not at inc reased risk of death after Tx. This information supports the growing e xperience with older donors and recipients and with bridged transplant s, and has allowed us to expand our donor pool. These prognostic facto rs at evaluation allow more liberal selection of patients and donors f or transplantation. (C) 1998 by The Society of Thoracic Surgeons.