200 Cases Of Heart Transplant Medium-term Survival And Risk Factors Analysis

Background:Risk factors for death after heart transplantation (HT) are frequently documented from International Heart and Lung Transplant Society(ISHLT). Although this information is helpful, it reflects a whole range of experiences and results, and may not translate to a particular center. This study was performed to (1) compare the preoperative recipient characteristics of Fuwai single-center with recipient characteristics of ISHLT registry data. (2) evaluate pre-HT factors affecting mortality in a Fuwai single-center experiences, and (3) compare these factors with risk factors obtained from ISHLT report. Methods:Review of our transplant database between Jun.2004 and May.2010 identified all 200 consecutive recipients. Kaplan-Meier method was used to calculate survival rates. The characteristics of preoperative recipients, whole survival rates, survival rates by age group and cumulative incidences of leading causes of death in our center were all compared with ISHLT data. Univariate analysis and multivariate logistic regression analysis were used to evaluate our center risk factors. The immunosuppressive regimen and follow-up mode from our center were assessed by endomyocardial biopsy (EMB) pathological results and followed-up outcome. Results: Compared with recipient characteristics of ISHLT, several different characteristics in our center include longer ischemia time, lower height,higher PVR level and more recipients with valvular disease which may adversely affect overall survival rate, but the characteristics of younger age, lower body weight, lower height, lower body mass index, higher proportion of cardiomyopathy recipient, lower proportion of coronary heart disease recipient and lower proportion of mechanical assist recipient may benefit overall survival rate in our center. Atl-,2-,3-,4-and 5-year, the survival rates of 200 recipients in our center were 94.4%,92.8%,91.9%,88.8% and 88.8%,which was higher than 85.8%, 82.1%,79.0%,75.9% and 72.7% of ISHLT recipient all p<0.01),respectively. At 3 months,1 year and 5 years, the mortality of primary cardiac failure in our center(0.63%, 0.63% and 1.25%)had no significant difference with mortality of ISHLT report(2.23%.2.48% and 2.9%; all p>0.05); the mortality of secondary cardiac failure in our center (0.63%,1.88% and 1.88%) had no significant difference with mortality of ISHLT report(1.26%,1.72% and 3.22%; all p>0.05); the infection mortality was 0 in our center, but 2.12%,3.17% and 4.22% in ISHLT report (p>0.05,<0.05and<0.01) Univariate analysis showed risk factors adversely affecting recipient mediun-term survival including preoperative recipient's diastolic pulmonary arterial pressure(dPAP), serum creatinine and NT-proBNP level in our center. However, not including donor ischemia time, preoperative recipient's age, UNOS-1 status, gender, blood type and the different causes of heart failure, preoperative left atrial and left ventricular end diastolic diameter, and left ventricular ejection fraction; cardiac index, pulmonary vasculrar resistance(PVR). Multivariate regression analysis showed that only preoperative serum creatinine level was risk factor adversely affecting recipient mediun-term survival (p <0.05) in our center. Univariate analysis showed preoperative recipient's weight, height, systolic pulmonary arterial pressure dPAP, mean pulmonary arterial pressure(mPAP), pulmonary capillary wedge pressure, total bilirubin, serum creatinine and high NT-proBNP level were risk factors of medium-term cardiac allograft mortality. Multivariate regression analysis showed that preoperative recipient's weight (p= 0.057) and mPAP (p<0.05) were risk factors affecting mid-term cardiac allograft mortality. Followed our center immunosuppressive regimen, this group of recipients with routine EMB 652 cases, showed the proportion of all levels of acute cell rejection:Grade Illb andâ…£:0, Gradeâ…¢a 2.9%, Gradeâ…¡9.5%, Gradeâ… b 2.3%, Grade la 25.4%, Grade O 59.9%. Cardiac allograft dysfunction or ventricular hypertrophy identified by echocardiogram evolved EMB 12 cases, and Gradeâ…¢b accounted 16.7%, Gradeâ…¢a 41.7%,Gradeâ…¡8.3%, Gradeâ… b 8.3%% GradeO 16.7%. At 3 months,1 year and 5-year, acute rejection mortality had no significant difference between our center and ISHLT(0.63% vs. 0.86%,1.25% vsl.29%and 1.25% vsl.94%).Conclusion:Although donor with longer ischemia time, recipients with lower height, higher PVR level and higher proportions of valvular disease recipients, the survival rates in our center were 8.9%-16.0% higher than those in ISHLT report postoperative 1-5 years. By combination our immunosuppressive regimen and rejection surveillance of low frequent endomyocardial biopsies, the recipients in our center occurred similar acute rejection mortality and lower infection mortality compared with ISHLT outcomes. Under control of recipient and donor inclusion criteria in our center, neither donor ischemia time nor preoperative PVR was risk factor on cardiac allograft and recipient mediun-term survival.