title: [Heart transplantation in the 21st century in Netherlands: improved survival in the last decade].
abstract: OBJECTIVE
  Over the past decades donor and recipient characteristics and medical management of heart transplantations patients have changed markedly. We studied the impact of these changes on long-term clinical outcome.
  
  
  METHODS
  Data of all consecutive heart transplant recipients in our center have been collected prospectively. Cohort A (n = 353 patients) was defined as the patients transplanted between 1984 and 1999, and was compared with cohort B (n = 227 patients) transplanted between 2000 and 2013.
  
  
  RESULTS
  Compared to cohort A, recipients in cohort B had older donors (mean age 29 vs. 43 years, donors aged > 50 year: 2% vs. 33%, respectively). One-year survival in cohort A vs. B was 89% vs. 86% and at 10 years 53% vs. 68%, respectively (p = 0.02). Cohort B patients were treated more often with tacrolimus based immunosuppression (77% vs. 22%; p < 0.001), and early statins post-heart transplantation (88% vs. 18%; p = 0.001), while renal function was better conserved at 5 and 10 years (p = 0.001 and 0.02). Multivariate analysis showed significant reduction in 10 years mortality with tacrolimus-based immunosuppression (HR: 0.27 and 95% CI 0.17-0.42), treatment of hypertension (HR: 0.5, 95% CI 0.36-0.72) and revascularization (HR: 0.28, 95% CI 0.15-0.52).
  
  
  CONCLUSIONS
  In spite of the use of much older donors, the long-term outcome after heart transplantation has improved considerably in the last decade, probably due to the introduction of newer treatment modalities.
authors.affiliation: Erasmus MC, Rotterdam.
authors.forename: Laurien E
authors.initials: LE
authors.lastname: Zijlstra
authors.forename: Alina  A
authors.initials: A
authors.lastname: Constantinescu
authors.forename: Olivier
authors.initials: O
authors.lastname: Manintveld
authors.forename: Ozcan
authors.initials: O
authors.lastname: Birim
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Hesselink
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Thiel
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Aggie H M M
authors.initials: AH
authors.lastname: Balk
authors.forename: Kadir
authors.initials: K
authors.lastname: Caliskan
mesh_terms: D000328:Adult; D000367:Age Factors; D046148:Donor Selection / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends*; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D016559:Tacrolimus