Impact of current management practices on early and late death in move than 500 consecutive cardiac transplant recipients

Objective To study risk factors for early and late death after heart transp lantation in the current era. Summary Background Data The current cardiac transplant population differs f rom earlier periods in that an increasing number of sicker patients, such a s those with ventricular assist device (LVAD) support, prior cardiac allotr ansplantation, and pulmonary hypertension, are undergoing transplantation. In addition, sensitized patients constitute a greater proportion of the tra nsplanted population. Emphasis has been placed on therapies to prevent earl y graft loss, such as the use of nitric oxide and improved immunosuppressio n, in addition to newer therapies. Methods Five hundred thirty-six patients undergoing heart transplantation b etween 1993 and 1999 at a single center were evaluated (464 adults and 72 c hildren; 109 had received prior LVAD support and 24 underwent retransplanta tion). The mean patient age at transplantation was 44.9 years. Logistic reg ression and Cox proportional hazard models were used to evaluate the follow ing risk factors on survival: donor and recipient demographics, ischemic ti me, LVAD, retransplantation, pretransplant pulmonary vascular resistance, a nd immunologic variables (ABO, HLA matching, and pretransplant anti-HLA ant ibodies). Results The rate of early death (less than 30 days) was 8.5% in adults and 8.8% in children. The actuarial survival rate of the 536 patients was 83%, 77%, and 71% at 1, 3, and 5 years, respectively, by Kaplan Meier analysis. Risk factors adversely affecting survival included the year of transplant, donor age, and donor-recipient gender mismatching. Neither early nor late d eath was influenced by elevated pulmonary vascular resistance, sensitizatio n, prior LVAD support, or prior cardiac allotransplantation. Conclusions Previously identified risk factors did not adversely affect sho rt-or long-term survival of heart transplant recipients in the current era. The steady improvement in survival during this period argues that advances in transplantation have offset the increasing acuity of transplant recipie nts.