Improved long‐term survival in D utch heart transplant patients despite increasing donor age: the R otterdam experience

Summary Over the past decades donor and recipient characteristics and medical management of heart transplantation ( HT ) patients have changed markedly. We studied the impact of these changes on long‐term clinical outcome. Data of all consecutive HT recipients in our center have been collected prospectively. Cohort A ( n  = 353) was defined as the adult pts transplanted between 1984 and 1999 and was compared with cohort B ( n  = 227) transplanted between 2000 and 2013. Compared with cohort A, recipients in cohort B had older donors (mean age 29 vs. 43 years, donors aged >50 year: 2% vs. 33%, respectively). Survival at 1 and 10 years in cohort A vs. B was 89% vs. 86% and 53% vs. 68%, respectively ( P  = 0.02). Cohort B pts were treated more often with tacrolimus‐based immunosuppression (77% vs. 22%; P  = <0.0001) and early statins post‐ HT (88% vs. 18%; P  = 0.0001), while renal function was better conserved at 5 and 10 years ( P  = 0.001 and 0.02). Multivariate analysis showed significant reduction in 10‐year mortality with tacrolimus‐based immunosuppression ( HR 0.27 and 95% CI 0.17–0.42), hypertension post‐HT ( HR 0.5, 95% CI 0.36–0.72), and revascularization ( HR 0.28, 95% CI 0.15–0.52). In spite of the use of much older donors, the long‐term outcome after HT has improved considerably in the last decade, probably due to the introduction of newer treatment modalities.