Thirty years of heart transplantation at the University Medical Centre Utrecht

Abstract

Purpose: To analyse patient demographics, indications, survival and donor characteristics for heart transplantation (HTx) during the past 30 years at the University Medical Centre Utrecht (UMCU).

Methods: Data have been prospectively collected for all patients who underwent HTx at the UMCU from 1985 until 2015. Patients who were included underwent orthotopic HTx at an age >14 years.

Results: In total, 489 hearts have been transplanted since 1985; 120 patients (25%) had left ventricular assist device (LVAD) implantation prior to HTx. A shift from ischaemic heart disease to dilated cardiomyopathy has been seen as the leading indication for HTx since the year 2000. Median age at HTx was 49 years (range 16-68). Median waiting time and donor age have also increased from 40 to 513 days and from 27 to 44 years respectively (range 11-65). Donor cause of death is now primarily stroke, in contrast to head and brain injury in earlier years. Estimated median survival is 15.4 years (95% confidence interval 14.2-16.6) There is better survival throughout these years.

Conclusion: Over the past 30 years, patient and donor demographics and underlying diseases have shifted substantially. Furthermore, the increase in waiting time due to lack of available donor hearts has led to a rise in the use of LVADs as bridge to transplant. Importantly, an improvement in survival rates is found over time which could be explained by better immunosuppressive therapy and improvements in follow-up care.

Keywords: Demography; HTx; Heart transplantation; LVAD; Left ventricular assist device; Utrecht.

Fig. 1

From referral to transplantation (PHT pulmonary hypertension, HTx heart transplantation, CRTD cardiac resynchronisation therapy device)

Fig. 2

Number of transplants, indication for transplantation and median waiting time

Fig. 3

Overall survival, conditional survival and survival in groups