4.7 Article

The Stanford experience of heart transplantation over five decades

期刊

EUROPEAN HEART JOURNAL
卷 42, 期 48, 页码 4934-+

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OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehab416

关键词

Heart transplantation; Outcomes; History

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In this retrospective study from Stanford University's heart transplant programme spanning fifty years, it was found that long-term survival has improved over time despite older recipients and donors, worsening comorbidities, increased technical complexity, and prolonged total allograft ischemia time. Further research is needed to understand the factors contributing to the positive outcomes observed in this study.
Aims Since 1968, heart transplantation has become the definitive treatment for patients with end-stage heart failure. We aimed to summarize our experience in heart transplantation at Stanford University since the first transplantation performed over 50 years ago. Methods and results From 6 January 1968 to 30 November 2020, 2671 patients presented to Stanford University for heart transplantation, of which 1958 were adult heart transplantations. Descriptive analyses were performed for patients in 1968-95 (n=639). Stabilized inverse probability weighting was applied to compare patients in 1996-2006 (n=356) vs. 2007-19 (n=515). Follow-up data were updated through 2020. The primary endpoint was all-cause mortality. Prior to weighting, recipients in 2007-19 vs. those in 1996-2006 were older and had heavier burden of chronic diseases. After the application of stabilized inverse probability weighting, the distance organ travelled increased from 84.2111.1 miles to 159.3 +/- 169.9 miles from 1996-2006 to 2007-19. Total allograft ischaemia time also increased over time (199.6 +/- 52.7 vs. 225.3 +/- 50.0min). Patients in 2007-19 showed superior survival than those in 1996-2006 with a median survival of 12.1 vs. 11.1years. Conclusion In this half-century retrospective descriptive study from one of the largest heart transplant programmes in the USA, long-term survival after heart transplantation has improved over time despite increased recipient and donor age, worsening comorbidities, increased technical complexity, and prolonged total allograft ischaemia time. Further investigation is warranted to delineate factors associated with the excellent outcomes observed in this study.

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