Cardiology Letters 2023, 32(4):235-245

Survival and causes of death in patients after heart transplantation in the Slovak Republic

Luknár M^{1, 2}, Hladká M², Lesný P^{1, 2}, Hulman M^{1, 2}, Olejárová I¹, Goncalvesová E^{1, 2}

² Národný ústav srdcových a cievnych chorôb, a. s., Bratislava

² Lekárská fakulta Univerzita Komenského a NÚSCH, a.s., Bratislava, Slovenská republika

Background: Heart transplantation (HTx) is an established therapeutic method for a highly selected group of patients with terminal heart disease, unfavourable prognosis, and exploited options of pharmacological, device or surgical treatment. Morbidity and mortality of HTx recipients is determined by a variety of factors ranging from donor and recipient characteristics, peri-operative circumstances to risks of long-term immunosupressive treatment. There is a lack of data on survival and causes of death of HTx patients in the Slovak Republic. The aim of this paper was to analyse the survival and causes of death in patients who underwent HTx in the Slovak Republic.

Patients and methods: The cohort consisted of 363 patients who underwent HTx at the National Cardiovascular Institute in Bratislava from March 21, 1998, to August 31, 2021. The patients are under a regular follow-up by the Centre, which keeps a registry of basic data. Recorded causes of death and selected indicators that are likely to influence the survival after HTx were analysed. Data that were not recorded in the registry were extracted from the available patient health records.

Results: As of September 30, 2021, 144 (40%) of 363 patients died. Median survival of all HTx recipients was 14.8 (0 - 23) years. 30-day and one-year mortality rates were 9.6% and 17.1%, resp. The most common cause of death was non-specific graft failure (20%), followed by infection (15%) and sudden death (14%). Other causes included cardiac allograft vasculopathy (11%), malignancy (10%), and acute rejection (6%). In 24% of cases, the cause of death was represented by various and less common conditions (renal failure, bleeding, ileus, ischemic stroke, trauma, and other). In the early period (<30 days post-op, n = 35), graft failure, infection, and bleeding represented the main causes of death (57%, 14%, and 12%, resp.). From 30 days to 1 year (n = 27), infection and sudden death prevailed (44% and 19%, resp.). Sudden death, rejection, and malignancies were the dominant causes of death from 1 year to 5 years (n = 22; 50%, 23%, and 18%, resp.). After 5 years (n = 60), cardiac allograft vasculopathy, malignancies, and graft failure were responsible for most of the deaths (25%, 17%, and 11%, resp.). Recipients with a heart from donors ≥ 40 years of age were statistically significantly less likely to survive than recipients with the graft from a younger donor (median 13.4 years vs. 14.5 years; p <0.05). No statistically significant differences in posttransplant survival depending on recipient's age, gender, primary diagnosis, pre-transplant left ventricular assist device implantation, and donor age and cause of death were found.

Conclusion: Survival of the Slovak patients after HTx is comparable to international registries. The structure of causes of death is evolving with the time from surgery and reflects the dynamics of risk in particular periods after HTx. Our results document the high standard of long-term care of patients after HTx in the Slovak Republic. The main areas of potential improvement are immediate peri-operative graft and recipient care, prevention of sudden death, as well as prevention and early diagnosis of malignancies after HTx.

Keywords: heart transplantation; causes of death; mortality; survival; recipient; donor

Published: April 1, 2023  Show citation