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Consistent improvements in short‐ and long‐term survival following heart transplantation over the past three decades
Author(s) -
Reul Ross M.,
Zhang Theodore S.,
Rana Abbas A.,
Rosengart Todd K.,
Goss John A.
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14241
Subject(s) - medicine , proportional hazards model , survival analysis , heart transplantation , transplantation , surgery , gerontology
Background Despite noted improvements in short‐term survival outcomes following orthotopic heart transplantation (OHT), review of the relevant literature suggests little improvement in long‐term outcomes for patients surviving beyond 1 year. Methods All OHT cases performed between 1989 and 2019 within the United Network for Organ Sharing (UNOS) database were reviewed. Adults who underwent isolated OHT were included in a 1‐year survival analysis. Those who survived at least 1 year post‐transplant were included in a long‐term survival analysis. Demographic factors were assessed using Students’ t test and chi‐square analysis. Survival trends and risk factors were assessed using the Kaplan‐Meier and the Cox regression analysis, respectively. Results A total of 53 265 and 46 372 recipients were included in the short‐term and long‐term cohorts, respectively. In an adjusted analysis, the reference implant era 2014‐2019 had significantly better short‐term survival outcomes when compared with earlier implant eras: 1989‐1993 (HR: 2.92), 1994‐1998 (HR: 1.53), 1999‐2003 (HR: 1.27), 2004‐2008 (HR: 1.11), and 2009‐2013 (HR: 1.02). The same trend was recognized for long‐term outcomes: 1989‐1993 (HR: 1.87), 1994‐1998 (HR: 1.27), 1999‐2003 (HR: 1.09), and 2004‐2008 (HR: 1.03). Conclusions Despite increases in multiple traditional risk factors, both short‐term and long‐term survival outcomes have consistently improved over the past 30 years, suggesting other factors are contributing to improved outcomes in recent eras.