title: Continuous improvement in outcome after heart transplantation - Long-term follow-up after three decades of experience.
abstract: OBJECTIVE
  Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. We report on the long-term outcome after HTx at our centre and investigate trends in outcome over time.
  
  
  METHODS
  During the period, between 1984 and 2014, a total of 610 HTx procedures were performed in 595 patients (median 48years; IQR 31-57years; range 24days-71years; mean 43years; 75% male) in our institution. Long-term outcome was investigated in the whole cohort, among children (n=76), bridged with mechanical circulatory support (MCS, n=131), re-transplanted (n=17), and concomitant kidney transplantation (n=12).
  
  
  RESULTS
  Long-term survival was at 1, 5, 10, 15 and 20years: 86% (95CI 0.83-0.89); 77% (95CI 0.73-0.80); 63% (95CI 0.59-0.68); 48% (95CI 0.43-0.54) and 30% (95CI 0.25-0.36), respectively. The median survival for the whole cohort was 14.1years. Patients transplanted during the most recent time period (2010-2014) had a better survival compared to previous eras, with a 1- and 3-year survival of 94% (95CI 0.89-0.97) and 93% (95CI 0.88-0.96), respectively (p<0.001). However, when survival was analysed for long-term MCS (n=80) versus short term MCS (n=35), there was a significantly poorer survival for the short-term MCS group (p=0.001). Independent predictors of long-term mortality included recipient age (p=0.041); previous smoking (p=0.034); ischemic heart disease (p=0.002); and preoperative ventilator therapy (p=0.004).
  
  
  CONCLUSIONS
  We have shown that continuous improvement in outcome after HTx still occurs. In the last time era, direct transplantation from short-term MCS was abandoned, which may have inflicted outcome during the last time era.
authors.affiliation: Transplant Institute, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden; Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. Electronic address: goran.dellgren@vgregion.se.
authors.forename: Göran
authors.initials: G
authors.lastname: Dellgren
authors.affiliation: Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Westerlind
authors.affiliation: Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Liden
authors.affiliation: Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Gäbel
authors.affiliation: Dept Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Bartfay
authors.affiliation: Dept Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Entela
authors.initials: E
authors.lastname: Bollano
authors.affiliation: Dept of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Holmberg
authors.affiliation: Dept Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Bert
authors.initials: B
authors.lastname: Andersson
authors.affiliation: Dept Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Schersten
authors.affiliation: Dept Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
authors.forename: Kristjan
authors.initials: K
authors.lastname: Karason
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Heart transplantation; Mechanical circulatory support - long-term follow-up