Trends in adult heart transplantation: a national survey from the United Kingdom Cardiothoracic Transplant Audit 1995-2007.
OBJECTIVE
The management of heart failure (HF), peri-transplant care and immunosuppression has changed in the last decade. Here we describe the changes that have occurred in the UK national programme of adult heart transplantation (HTx).


METHODS
Using the data accrued with the UK Cardiothoracic Transplant Audit we undertook a prospective cohort study of 2958 consecutive adult patients listed for HTx and 2005 adult orthotopic HTx performed in three time periods - Era-1 (July 1995-March 1999, 1321 listed, 907 transplanted), Era-2 (April 1999-March 2003, 842 listed, 600 transplanted) and Era-3 (April 2003-March 2007, 795 listed, 498 transplanted).


RESULTS
The median time on the waiting list reduced from 109 days in Era-1 to 40 days in Era-3. The proportion of HTx in non-ambulatory HF patients requiring inotropic or circulatory support increased from 12% in Era-1 to 35% in Era-3. The proportion undergoing HTx for non-ischaemic dilated cardiomyopathy increased from 40% in Era-1 to 58% in Era-3 while ischaemic cardiomyopathy decreased. Survival after HTx remained constant (81% (95% CI: 78-83%) at 1 year in Era-1 and 80% (95% CI: 77-84%) in Era-3). There was an increase in the use of mycophenolate and induction therapy and a reduction in rejection episodes over the eras.


CONCLUSIONS
Although waiting list and HTx activity have declined, HTx continues to have an important role in the management of advanced HF, especially for patients on inotropic or circulatory support. Despite a deterioration of donor organ quality, survival after HTx has remained unchanged.
Thekkudan
Joyce
J
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Rogers
Chris A
CA
Thomas
Helen L
HL
van der Meulen
Jan H P
JH
Bonser
Robert S
RS
Banner
Nicholas R
NR
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D016027:Heart Transplantation / Q000639:trends*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D006113:United Kingdom / Q000453:epidemiology; D014850:Waiting Lists