Characteristics of patients with survival longer than 20 years following heart transplantation.
OBJECTIVE
The number of heart-transplant recipients exceeding 20 years of follow-up is steadily increasing. However, little is known about their functional status, comorbidities, and mortality. Identifying the predictors of prolonged survival could guide the selection of candidates for the low number of available donors.


METHODS
Functional status, morbidities, and mortality of heart-transplant patients between 1984 and 1992 were analyzed. To identify predictors of 20-year survival, a logistic regression model was constructed using the covariates associated with survival in the univariate analysis.


RESULTS
A total of 39 patients who survived 20 years (26% of patients transplanted before 1992) were compared to 90 recipients from the same period who died between 1 and 20 years post-transplantation. Major complications were hypertension, renal dysfunction, infections, and cancer. After a mean follow-up of 30 months, 6 survivors had died, yielding a mortality rate of 6% per year (vs 2.5%-3% in years 1-19). Causes of mortality were infection (50%), malignancy (33%), and allograft vasculopathy (17%). Long-term survivors were younger and leaner, and had nonischemic cardiomyopathy and lower ischemic time. Logistic regression identified recipient age <45 years (odds ratio=3.9; 95% confidence interval, 1.6-9.7; P=.002) and idiopathic cardiomyopathy (odds ratio=3; 95% confidence interval, 1.4-7.8; P=.012) as independent predictors for 20-year survival.


CONCLUSIONS
One fourth of all heart-transplant patients in our series survived >20 years with the same graft, and most enjoy independent lives despite significant comorbidities. Recipient age <45 years and idiopathic cardiomyopathy were associated with survival beyond 2 decades. These data may help decide donor allocation.
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain. Electronic address: nataliajllo53@hotmail.com.
Natalia
N
Jaramillo
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Javier
J
Segovia
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Manuel
M
Gómez-Bueno
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Dolores
D
García-Cosío
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Evaristo
E
Castedo
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Santiago
S
Serrano
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Raúl
R
Burgos
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Carlos
C
García Montero
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Juan
J
Ugarte
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Paloma
P
Martínez Cabeza
Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Luis
L
Alonso-Pulpón
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality* / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult
Calidad de vida; Heart transplantation; Quality of life; Supervivencia; Survival rate; Trasplante