What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors

Arman Kilic, Eric S. Weiss, Timothy J. George, George J. Arnaoutakis, David D. Yuh, Ashish S. Shah, John Conte

Research output: Contribution to journalArticle

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Abstract

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 volume 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.

Original languageEnglish (US)
Pages (from-to)699-704
Number of pages6
JournalAnnals of Thoracic Surgery
Volume93
Issue number3
DOIs
StatePublished - Mar 1 2012

Fingerprint

Heart Transplantation
Survivors
Odds Ratio
Confidence Intervals
Survival
Artificial Respiration
Tissue Donors
Registries
Case-Control Studies
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kilic, Arman ; Weiss, Eric S. ; George, Timothy J. ; Arnaoutakis, George J. ; Yuh, David D. ; Shah, Ashish S. ; Conte, John. / What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 3. pp. 699-704.
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title = "What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors",
abstract = "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 volume 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.",
author = "Arman Kilic and Weiss, {Eric S.} and George, {Timothy J.} and Arnaoutakis, {George J.} and Yuh, {David D.} and Shah, {Ashish S.} and John Conte",
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What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors. / Kilic, Arman; Weiss, Eric S.; George, Timothy J.; Arnaoutakis, George J.; Yuh, David D.; Shah, Ashish S.; Conte, John.

In: Annals of Thoracic Surgery, Vol. 93, No. 3, 01.03.2012, p. 699-704.

Research output: Contribution to journalArticle

TY - JOUR

T1 - What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors

AU - Kilic, Arman

AU - Weiss, Eric S.

AU - George, Timothy J.

AU - Arnaoutakis, George J.

AU - Yuh, David D.

AU - Shah, Ashish S.

AU - Conte, John

PY - 2012/3/1

Y1 - 2012/3/1

N2 - 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 volume 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.

AB - 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 volume 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.

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