title: Risk factor analysis of late survival after heart transplantation according to donor profile: a multi-institutional retrospective study of 512 transplants.
abstract: BACKGROUND
  Patients with terminal heart failure have increased more than the available organs leading to a high mortality rate on the waiting list. Use of Marginal and expanded criteria donors has increased due to the heart shortage.
  
  
  OBJECTIVE
  We analyzed all heart transplantations (HTx) in Sao Paulo state over 8 years for donor profile and recipient risk factors.
  
  
  METHODS
  This multi-institutional review collected HTx data from all institutions in the state of Sao Paulo, Brazil. From 2002 to 2008 (6 years), only 512 (28.8%) of 1777 available heart donors were accepted for transplantation. All medical records were analyzed retrospectively; none of the used donors was excluded, even those considered to be nonstandard.
  
  
  RESULTS
  The hospital mortality rate was 27.9% (n = 143) and the average follow-up time was 29.4 ± 28.4 months. The survival rate was 55.5% (n = 285) at 6 years after HTx. Univariate analysis showed the following factors to impact survival: age (P = .0004), arterial hypertension (P = .4620), norepinephrine (P = .0450), cardiac arrest (P = .8500), diabetes mellitus (P = .5120), infection (P = .1470), CKMB (creatine kinase MB) (P = .8694), creatinine (P = .7225), and Na+ (P = .3273). On multivariate analysis, only age showed significance; logistic regression showed a significant cut-off at 40 years: organs from donors older than 40 years showed a lower late survival rates (P = .0032).
  
  
  CONCLUSIONS
  Donor age older than 40 years represents an important risk factor for survival after HTx. Neither donor gender nor norepinephrine use negatively affected early survival.
authors.affiliation: Heart Institute of Sao Paulo University Medical School, Sao Paulo, Brazil. fiorelliai@uol.com.br
authors.forename: A I
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: J N
authors.initials: JN
authors.lastname: Branco
authors.forename: J J
authors.initials: JJ
authors.lastname: Dinkhuysen
authors.forename: J L
authors.initials: JL
authors.lastname: Oliveira Junior
authors.forename: T V
authors.initials: TV
authors.lastname: Pereira
authors.forename: L F L
authors.initials: LF
authors.lastname: Dinardi
authors.forename: M M
authors.initials: MM
authors.lastname: Santos
authors.forename: R R
authors.initials: RR
authors.lastname: Dias
authors.forename: L A
authors.initials: LA
authors.lastname: Pereira
authors.forename: N A G
authors.initials: NA
authors.lastname: Stolf
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D001938:Brazil; D016009:Chi-Square Distribution; D015897:Comorbidity; D046148:Donor Selection; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000627:therapeutic use; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D009638:Norepinephrine