Marital status improves survival after orthotopic heart transplantation

Abstract

Background: Large national registries lack information on social support, which is increasingly recognized as an important factor associated with improved outcomes after solid-organ transplantation. We examined our institutional database to identify social factors associated with improved outcomes after orthotopic heart transplantation (OHT).

Methods: Outcomes of OHT patients from 1995 to 2010 at our institution were retrospectively reviewed. Clinical data and social information were extracted from medical records. Patients were stratified by marital status at time of OHT listing. The examined outcome was 5-year survival, excluding deaths within 60 days, modeled using the Kaplan-Meier method. A Cox multivariable hazard regression model was constructed to assess the effect on 5-year survival.

Results: Of 260 OHT recipients, 176 (68%) were men. Mean age was 49 ± 12 years and mean body mass index was 26.8 ± 5.0 kg/m(2). At the time of OHT listing, 175 patients (68%) were married. Before OHT, 25% were supported with ventricular assist devices and 17% were in the intensive care unit. Conditional Kaplan-Meier analysis revealed improved 5-year survival for married patients (84%) compared with unmarried patients (69%). After risk-adjustment with Cox analysis, being married improved 5-year survival (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.23-0.97; p = 0.042) and also improved 1-year survival (p = 0.02). Other social support variables (children, grandchildren, living arrangements, education, race, employment status) were not associated with mortality.

Conclusions: Married patients have improved survival after OHT compared with unmarried patients. Being married confers a powerful 5-year survival advantage after OHT. This benefit appears mediated by an improvement in survival during the first post-transplant year.