loading page

20-Year Survival Following Orthotopic Heart Transplantation in the United States
  • +4
  • Nicholas Hess,
  • Laura Seese,
  • Michael Mathier,
  • Mary Keebler,
  • Gavin Hickey,
  • Dennis McNamara,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center

Corresponding Author:[email protected]

Author Profile
Laura Seese
University of Pittsburgh Medical Center Health System
Author Profile
Michael Mathier
University of Pittsburgh Medical Center Health System
Author Profile
Mary Keebler
University of Pittsburgh Medical Center Health System
Author Profile
Gavin Hickey
University of Pittsburgh Medical Center Health System
Author Profile
Dennis McNamara
University of Pittsburgh Medical Center
Author Profile
Arman Kilic
University of Pittsburgh Medical Center Health System
Author Profile

Abstract

Background: This study evaluated 20-year survival following adult orthotopic heart transplantation (OHT). Methods: The United Network of Organ Sharing Registry database was queried to study adult OHT recipients between 1987-1998 with over 20-year posttransplant follow-up. The primary and secondary outcomes were 20-year survival and cause of death following OHT, respectively. Multivariable logistic regression was used to identify significant independent predictors of long-term survival, and long-term survival was compared among cohorts stratified by number of predictors using Kaplan Meier survival analysis. Results: 20,658 patients undergoing OHT were included, with median follow-up of 9.0 (IQR 3.2-15.4) years. Kaplan-Meier estimates of 10-, 15-, and 20-year survival were 50.2%, 30.1%, and 17.2%, respectively. Median survival was 10.1 (IQR 3.9-16.9) years. Increasing recipient age (>65 years), increasing donor age (>40 years), increasing recipient BMI (>30), black race, ischemic cardiomyopathy, and longer cold ischemic time (>4 hours) were adversely associated with 20-year survival. Of these 6 negative predictors, presence of 0 risk factors had the greatest 10-year (59.7%) and 20-year survival (26.2%), with decreasing survival with additional negative predictors. The most common cause of death in 20-year survivors was renal, liver, and/or multisystem organ failure whereas graft failure more greatly impacted earlier mortality. Conclusions: This study identifies six negative preoperative predictors of 20-year survival with 20-year survival rates exceeding 25% in the absence of these factors. These data highlight the potential for very long-term survival following OHT in patients with end-stage heart failure and may be useful for patient selection and prognostication.
06 Jun 2020Submitted to Journal of Cardiac Surgery
09 Jun 2020Submission Checks Completed
09 Jun 2020Assigned to Editor
16 Jul 2020Reviewer(s) Assigned
11 Oct 2020Review(s) Completed, Editorial Evaluation Pending
11 Oct 2020Editorial Decision: Accept