Survival Analysis in Adult Heart Transplantation: Experience from a Brazilian Single Center

TL;DR

This study analyzes survival rates and risk factors for early mortality in adult heart transplant patients at a Brazilian center over 10 years.

Contribution

The study provides insights into survival trends and risk factors specific to a Brazilian heart transplant center.

Findings

Overall survival rates were 68.1% at one year, 58% at five years, and 40.8% at 10 years.

Survival improved significantly in recent years, with 73.2% at one year and 63% at five years from 2016 to 2022.

Key risk factors for 30-day mortality included donor age, donor weight, and time on cardiopulmonary bypass.

Abstract

Heart transplantation is the gold standard for advanced heart failure
treatment. This study examines the survival rates and risk factors for early
mortality in adult heart transplant recipients at a Brazilian center.

This retrospective cohort study involved 255 adult heart transplant patients
from a single center in Brazil. Data were collected from medical records and
databases including three defined periods (2012-2015, 2016-2019, and
2020-2022). Statistical analysis employed Kaplan-Meier survival curves, Cox
proportional hazards analysis for 30-day mortality risk factors, and
Log-rank tests.

The recipients were mostly male (74.9%), and the mean age was 46.6 years.
Main causes of heart failure were idiopathic dilated cardiomyopathy (33.9%),
Chagas cardiomyopathy (18%), and ischemic cardiomyopathy (14.3%). The study
revealed an overall survival of 68.1% at one year, 58% at five years, and
40.8% at 10 years after heart transplantation. Survivalimproved
significantly over time, combining the most recent periods (2016 to 2022) it
was 73.2% in the first year and 63% in five years. The main risk factors for
30-day mortality were longer time on cardiopulmonary bypass, the initial
period of transplants (2012 to 2015), older age of the donor, and
nutritional status of the donor (overweight or obese). The main causes of
death within 30 days post-transplant were infection and primary graft
dysfunction.

The survival analysis by period demonstrated that the increased surgical
volume, coupled with the team’s experience and modifications to the
immunosuppression protocol, contributed to the improved early and mid-term
outcomes.

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