Recipient Related Predictors of Mortality after Heart Transplantation: Results from a Contemporary Irish National Cohort

Orthotopic Heart Transplantation (OHT) remains the optimal therapy for advanced symptomatic heart failure. Assessing outcomes is important, not only to the transplant centre but also to the referring heart failure services, to optimize and align expectations. Alongside advances in care older and more complex patients are being transplanted therefore it is important to validate survival in a contemporary cohort. We sought to assess the outcome following OHT in our contemporary cohort and to identify recipient risk factors of poor outcome. Diabetes, renal disease and advanced age at transplantation are all identified in the literature as predictors of poor outcomes post transplantation. A systematic analysis of all patients (n=100) transplanted in the ten-year period 2004-2013 attending follow up in the Irish OHT clinic was performed. This included patients transplanted in the Irish programme and young adults transitioned to the programme following paediatric OHT in the UK. Review of patient records together with laboratory data allowed completion of a standardized dataset for each patient. Survival was determined with reference to the clinical records. Statistical analysis was carried out with SPSS. Survival curves were generated and the log-rank scale used to compare survival amongst groups. Baseline characteristics are shown in table 1. One-year survival was 85% with death occurring in 25 patients, all surviving patients remained free of re-transplantation at the end of the period. Univariate determinants of increased mortality included female gender and CKD class at transplantation, but not age at transplantation or diabetes. Early deaths occurred more frequently in the ischaemic cohort, however they had a superior long-term survival (p 0.018). Our survival rates are in keeping with published data. We only identified renal impairment and female gender as predictors of poor outcome perhaps due to small numbers in our cohort.