title: Three decades of heart transplantation in Scandinavia: long-term follow-up.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Transplant Institute and Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45 Gothenburg, Sweden. goran.dellgren@vgregion.se
authors.forename: Göran
authors.initials: G
authors.lastname: Dellgren
authors.forename: Odd
authors.initials: O
authors.lastname: Geiran
authors.forename: Karl
authors.initials: K
authors.lastname: Lemström
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.forename: Hans
authors.initials: H
authors.lastname: Eiskjaer
authors.forename: Bansi
authors.initials: B
authors.lastname: Koul
authors.forename: Inger
authors.initials: I
authors.lastname: Hagerman
authors.forename: Nedim
authors.initials: N
authors.lastname: Selimovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult