Authors

• Mario Udovičić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-9912-2179
• Mira Stipčević — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-4351-1102
• Dubravka Jonjić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-9644-9739
• Vanja Ivanović — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6931-5404
• Željko Sutlić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6926-9436
• Igor Rudež — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-7735-6721
• Davor Barić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5955-0275
• Daniel Unić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2740-4067
• Mislav Planinc — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-9833-832X
• Boris Starčević — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-3090-2772

Keywords

heart failure, heart transplantation, prognosis

DOI

Full Text

Despite all efforts in conservative medical treatment and the availability of mechanical circulatory support, heart transplantation (HTx) remains the gold standard and treatment of choice for advanced heart failure refractory to other methods. (1, 2) In this study we report single center experience and outcomes of patients referred to HTx by Division of Cardiology, University Hospital Dubrava. All patients underwent HTx at the Department of Cardiac and Transplant Surgery of University Hospital Dubrava, and were subsequently referred for follow up in close collaboration of two departments. We retrospectively examined the outcomes from 70 HTx recipients between 1995 and October 2016. The mean recipient age was 53.9±7.7 years, and 84% were male. Dilated cardiomyopathy was present in 51%, ischemic in 43% and 6% were other causes. Ten recipients (14%) were placed either on high urgent list of Eurotransplant or on national high urgent list. As induction of immunosuppressive therapy antithymocyte globulin was used, while for maintenance we apply the concept of individualized immunosuppression, using combinations of drugs according to patients’ needs and occurrence of side effects. Survival was studied using Kaplan-Meier curves. Early in-hospital mortality was 12%. The global survival rates at 1, 5, and 10 years are 84%, 79% and 73% respectively. The mean survival is 134 months (95% CI, 114.1-153.4). Early main causes of death were sepsis (44%) and primary graft failure (19%) while late causes were cardiac allograft vasculopathy (13%), malignant disease and other causes (25%). In University Hospital Dubrava, post-HTx survival rates at 1, 5, and 10 years are better than those reported by the International Society of Heart and Lung Transplantation, as a result of careful selection of patients and combined effort of all medical personnel involved in pre-, peri- and postoperative management. Our program strives and continues to adopt new strategies to improve the quality of life and life expectancy of our HTx recipients.

Literature

1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975. https://doi.org/10.1002/ejhf.592
2. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases Council; International Society for Heart Lung Transplantation (ISHLT) Pediatric Transplantation Council; International Society for Heart Lung Transplantation (ISHLT) Heart Failure and Transplantation Council. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 2016;35(1):1–23. https://doi.org/10.1016/j.healun.2015.10.023