Three Decades of Heart Transplantation in Scandinavia: Long-Term Follow-Up

Eur J Heart Fail. 2013 Mar;15(3):308-15. doi: 10.1093/eurjhf/hfs160. Epub 2012 Oct 29.

Abstract

Aim: Heart transplantation (HTx) has become a standard treatment for patients with end-stage heart disease. The aim of this study was to report the long-term outcome after HTx in Scandinavia.

Methods and results: During the period, 1983-2009, 2333 HTxs were performed in 2293 patients (mean age 45 ± 16 years, range 0-70, 78% male). The main indications for HTx were non-ischaemic cardiomyopathy (50%), ischaemic cardiomyopathy (34%), valvular cardiomyopathy (3%), congenital heart disease (7%), retransplantation (2%), and miscellaneous (4%). The registry consists of pre-operative data from recipients and donors, data from pre-operative procedures, and long-term follow-up data. Mean follow-up was 7.8 ± 6.6 years (median 6.9, interquartile range 2.5-12.3, interval 0-27) and no patients were lost to follow-up. Long-term survival for HTx patients was 85, 76, 61, 43, and 30% at 1, 5, 10, 15, and 20 years of follow-up, respectively. Ten-year survival in patients bridged with mechanical circulatory support, in children, after retransplantation, and after concomitant other organ transplantation was 56, 74, 38, and 43%, respectively. Older patients (age > 55 years) had a significantly worse survival (P < 0.001). Patients transplanted more recently had a significantly better survival (P < 0.001). In a multivariate Cox regression analysis, independent predictors of long-term survival were recipient age (P < 0.001), donor age (P < 0.001), diagnosis (P = 0.001), and era of transplantation (P < 0.001).

Conclusions: HTx in Scandinavia proves to have a significantly better survival among patients transplanted in the last decade. HTxs from mechanical circulatory support, in children, after retransplantation, and with concomitant other organ transplantation were performed with acceptable results.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Cardiomyopathies / mortality
  • Cardiomyopathies / surgery*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery*
  • Heart Transplantation*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Registries*
  • Reoperation
  • Scandinavian and Nordic Countries / epidemiology
  • Treatment Outcome
  • Young Adult