What Predicts Long-Term Survival After Heart Transplantation? An Analysis of 9,400 Ten-Year Survivors

Background. This case-control study was conducted to identify factors predictive of 10-year survival after orthotopic heart transplantation (OHT). Methods. Prospectively collected data from the United Network for Organ Sharing registry were reviewed to identify adult patients undergoing OHT between 1987 and 1999 (N = 22,385) who had survived 10 years. Controls were those who had died within 10 years of OHT. Factors associated with 10-year survival were identified with multivariate logistic regression analysis. Lowess smoothing plots were used to identify linear breakpoints in continuous variables, and splines were incorporated when appropriate. Results. There were 9,404 ten-year survivors (42%; mean follow-up, 14.0 +/- 3.0 years) and 10,373 controls (46%) with a mean survival of 3.7 +/- 3.3 years post-OHT. Predictors of 10-year survival in the optimal multivariate model were age younger than 55 (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.10 to 1.38; p < 0.001), white race (OR, 1.35; 95% CI, 1.17 to 1.56; p < 0.001), shorter ischemic time (OR, 1.11; 95% CI, 1.05 to 1.18; p < 0.001), younger donor age (OR, 1.01; 95% CI, 1.01 to 1.02; p < 0.001), annual center volume of 9 or more (OR, 1.31; 95% CI, 1.17 to 1.47; p < 0.001), mechanical ventilation (OR, 0.53; 95% CI, 0.36 to 0.78; p = 0.001), and diabetes (OR, 0.67; 95% CI, 0.57 to 0.78; p < 0.001). Conclusions. Age younger than 55 years, annual center olume of 9 or more, white race, shorter ischemic time, and younger donor age improved the likelihood of 10-year survival after OHT. Mechanical ventilation and diabetes reduced this likelihood. These data should serve as a useful guide to long-term prognostication in adult OHT. (Ann Thorac Surg 2012;93:699-704) (C) 2012 by The Society of Thoracic Surgeons