Introduction: Russian National Research Centre of Transplantology and Artificial Organs is the leading national transplant center with 30 years’ experience of heart transplantation, which currently produces more than a half of all heart transplantations (HTx) performed in the country.
Objectives: The study was aimed to analyze changes in short-term and 5-year HTx outcomes during the last three decades.
Methods: Survival of 774 terminal heart failure patients who received with HTx in our Centre in different periods was studied. For the evaluation and comparative analysis of survival, the Kaplan-Meier method and the Cox proportional models were used.
Results: 800 HTx were performed in 776 patients between March 1986 and March 2017: 267 (34.3%) died, 11 (1.4%) lost from follow-up, 498 (64.3%) were alive at the end of October 2017. 25% of all deaths developed within the first week after surgery. In-hospital survival significantly improved from 0.65 ± 0.04 in 1986-2004 to 0.92 ± 0.02 in 2012-2017 (p=0.01). Five-year survival among those operated in 1986-1991, 1992-2004, 2004-2008, and 2009-2012 was 0.34 ± 0.08, 0.49 ± 0.08, 0.67 ± 0.09, and 0.85 ± 0.12, respectively (p for trend <0.05). Compared to 1986-2004, the 2012-2017 have shown significant increase in the number of HTx performed annually (5.6 ± 3.9 vs. 93.5 ± 12.0, respectively, p <0.001), recipients age (35.2 ± 11.6 vs 46.7 ± 13.7, respectively, p = 0.01), and donors age (31.3 ± 8.8 vs. 41.2 ± 11.0, respectively, p = 0.02).
Conclusions: Despite the more severe clinical status of recipients and expansion of the donor criteria, a significant progress of short and long-term survival was achieved as a result of the improvement in donation organization, perioperative care, immunosuppression, and patient management protocols.