What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors

Abstract

Background: This case-control study was conducted to identify factors predictive of 10-year survival after orthotopic heart transplantation (OHT).

Methods: Prospectively collected data from the United Network for Organ Sharing registry were reviewed to identify adult patients undergoing OHT between 1987 and 1999 (N=22,385) who had survived 10 years. Controls were those who had died within 10 years of OHT. Factors associated with 10-year survival were identified with multivariate logistic regression analysis. Lowess smoothing plots were used to identify linear breakpoints in continuous variables, and splines were incorporated when appropriate.

Results: There were 9,404 ten-year survivors (42%; mean follow-up, 14.0±3.0 years) and 10,373 controls (46%) with a mean survival of 3.7±3.3 years post-OHT. Predictors of 10-year survival in the optimal multivariate model were age younger than 55 (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.10 to 1.38; p<0.001), white race (OR, 1.35; 95% CI, 1.17 to 1.56; p<0.001), shorter ischemic time (OR, 1.11; 95% CI, 1.05 to 1.18; p<0.001), younger donor age (OR, 1.01; 95% CI, 1.01 to 1.02; p<0.001), annual center volume of 9 or more (OR, 1.31; 95% CI, 1.17 to 1.47; p<0.001), mechanical ventilation (OR, 0.53; 95% CI, 0.36 to 0.78; p=0.001), and diabetes (OR, 0.67; 95% CI, 0.57 to 0.78; p<0.001).

Conclusions: Age younger than 55 years, annual center volume of 9 or more, white race, shorter ischemic time, and younger donor age improved the likelihood of 10-year survival after OHT. Mechanical ventilation and diabetes reduced this likelihood. These data should serve as a useful guide to long-term prognostication in adult OHT.