title: Improved long-term survival in Dutch heart transplant patients despite increasing donor age: the Rotterdam experience.
abstract: 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.
authors.affiliation: Thoraxcenter, Unit Heart Failure & Transplantation, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Laurien E
authors.initials: LE
authors.lastname: Zijlstra
authors.affiliation: Thoraxcenter, Unit Heart Failure & Transplantation, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Alina A
authors.initials: AA
authors.lastname: Constantinescu
authors.affiliation: Thoraxcenter, Unit Heart Failure & Transplantation, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Olivier
authors.initials: O
authors.lastname: Manintveld
authors.affiliation: Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Birim
authors.affiliation: Division of Nephrology and Renal Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Hesselink
authors.affiliation: Thoraxcenter, Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: van Thiel
authors.affiliation: Thoraxcenter, Unit Clinical Epidemiology, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.affiliation: Thoraxcenter, Unit Heart Failure & Transplantation, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Aggie H M
authors.initials: AH
authors.lastname: Balk
authors.affiliation: Thoraxcenter, Unit Heart Failure & Transplantation, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Kadir
authors.initials: K
authors.lastname: Caliskan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D046148:Donor Selection / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies; D058996:Quality Improvement; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: heart transplantation; older donors; prognosis; survival