Twenty-five years of heart transplantation at Papworth Hospital: Changes in factors influencing short- and long-term patient survival over time

Abstract

years of heart transplantation data were used to identify factors associated with patient survival and investi- gate changes over time. Analysis was performed across 5 time eras - pre-triple therapy, post-triple therapy to 1990 and the remaining 15 years through 2005 divided into 3 groups of 5 years each. Both short- and long-term survival improved with the advent of triple therapy, but remained unchanged from the early 1990's. Mean donor and recipient age, proportion of female donors and recipients, transplants with two human leucocyte antigen (HLA)-DR mismatches, ischaemic and car- diopulmonary bypass times (CPB) have increased, while rates of rejection and infection have decreased over time. Female donor and recipient diagnosis were independent predictors of short-term mortality. Older age, recipient diagnosis, 2 or more early rejection episodes and number of HLA-A mismatches were independent predictors of mortality in the long- term. Survival rates after heart transplantation improved with advances in patient care, but have remained static since, dur- ing which time there have been increases in risk factors and use of more marginal donors.