Heart transplantation in Norway 1983–2023

Abstract

Background: November 2023 marked 40 years since heart transplantation was introduced as a treatment option for advanced heart failure in Norway. International registry data show a median post-transplant survival of slightly more than 11 years, with most centres performing 10-19 transplants annually. The aim of this study was to provide an overview of outcomes following heart transplantation in Norway.

Material and method: The study is a retrospective observational analysis of heart transplant recipients at Oslo University Hospital, Rikshospitalet, in the period 6 November 1983 to 31 December 2023. The focus is on patient and donor characteristics, survival and complications.

Results: Between 6 November 1983 and 31 December 2005, a median of 24 (interquartile range: 21-27) heart transplants were performed annually, compared with 32 (29-35) between 1 January 2006 and 31 December 2023. Among 1078 first-time transplant recipients, median survival was 13.4 years (95 % confidence interval (CI): 12.7-14.4). Median survival was 11.0 years (95 % CI: 9.3-12.9) for patients transplanted between 6 November 1983 and 31 December 1993; 13.1 years (95 % CI: 11.7-15.4) for those transplanted between 1 January 1994 and 31 December 2003; and 14.8 years (95 % CI: 13.5-16.8) for patients transplanted between 1 January 2004 and 31 December 2013. This was despite increasing donor age and a high proportion of recipients requiring intensive care or receiving mechanical circulatory support immediately prior to transplantation. Survival was highest among patients without ischemic heart failure. Various types of cancer, along with chronic/progressive graft failure (myocardial infarction, sudden death in the context of known graft vasculopathy/coronary disease/fibrosis), were the most common causes of death.

Interpretation: A steady improvement has been observed in survival following heart transplantation in Norway. Rikshospitalet performs among the highest volumes of heart transplants worldwide, with outcomes comparable to the leading international centres.