Has the Profile of Heart Transplantation Recipients changed within the last 3 decades? An analysis from a Swiss Heart Transplantation Center


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A Master's thesis.
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Master (thesis) (master)
Has the Profile of Heart Transplantation Recipients changed within the last 3 decades? An analysis from a Swiss Heart Transplantation Center
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Université de Lausanne, Faculté de biologie et médecine
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Background :
Heart transplantation (HTx) remains the most durable treatment for end-stage heart failure (HF) patients who are refractory to optimal treatment. Vasodilation, b-blockade, mineralocorticoid receptor antagonism and device therapy have increased survival and reduced morbidity in patients with HF in the last decades. This retrospective analysis of a local HTx cohort aimed to investigate how change in HF therapy impacted on the profile of HTx candidates and their posttransplant survival.
A total of 323 HTx recipients of the Lausanne University Hospital had 328 transplant operations between 1987 and 2018. Patients were separated into 3 groups on the basis of the disposability of HF therapy: period 1 (1987-1998, n=115) when only vasodilatory and diuretic treatments were available; period 2 (1999-2010; n=106) includes the years with b-blockers, mineralocorticoid receptor antagonists (MRA), cardiac resynchronization therapy (CRT) and automated implantable cardioverter-defibrillator (AICD), while period 3 (2011-2018; n=107) was marked by the increasing use of ventricular assist devices (VAD) for bridge to transplantation (BTT).
Between the three periods, there was no difference in patient characteristics such as age (all: 50.0±13.9 years; p=0.72), male sex (all: 79%; p=0.34) and body mass index (BMI) (all: 24.7±4.6; p=0.5). Arterial hypertension was less prevalent in period 2 (period 1 vs 2 vs 3: 44 vs 28 vs 43%; p=0.047); distribution of cardiovascular risk factors was not different between groups. Left ventricular ejection fraction (LVEF) was lower in period 1 (1 vs 2 vs 3: 20.3±0.47 vs 23.9±1.2 vs 26.4±1.5%; p=0.001); maximal oxygen consumption (pVO2 13.6±3.8; p=0.34) or pulmonary vascular resistance (PVR) (2.53 ± 1.34 Wood Units; p=0.34) were not different. The distribution of HF etiologies differed between periods (p<0.001). HF therapy significantly changed, with progressive increase of b-blockers, mineralocorticoid receptor antagonists, and assist device use with time. 1-year survival after HTx was higher in period 3 (1 vs 2 vs 3: 87.2±3.2 vs 70.8±4.4 vs 93.0±2.6%; p always £0.022) without association to pretransplant parameters.
This temporal analysis of a monocentric HTx cohort shows an improvement of 1-year survival after orthotopic heart transplantation in the years 2011-2018, when compared with the two earlier decades. The superior posttransplant survival in the years 2011-2018 was not related to pretransplant characteristics of HTx recipients, as the profile of HTx recipients did not largely change between the study periods.
Heart transplantation, Transplant recipient, Survival
Create date
09/09/2021 9:59
Last modification date
08/12/2022 7:52
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