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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.
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“T2DM was an independent risk factor for reduced 10-year survival in a large registry of 22 385 transplant patients.178”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [178]
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Durable left ventricular assist device in donation after circulatory death heart transplantation
Hong, Y., Nasim, U., Iyanna, N., Dorken‐Gallastegi, A., Keebler, M., Horn, E. T., Hickey, G., & Kaczorowski, D. J. (2025) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2025.01.016 · Cited by 9
Hong, Y., Hess, N. R., Ziegler, L. A., Dorken‐Gallastegi, A., Abdullah, M., Agrawal, N., Sultan, I. S., Horn, E. T., Hickey, G., Keebler, M., et al. (2025) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2024.09.012 · Cited by 8
Jung, J. S., Son, H. S., Lee, S. H., Lee, K. H., Son, K., & Sun, K. (2013) · Transplantation Proceedings · doi:10.1016/j.transproceed.2013.08.034 · Cited by 8
Textbook outcomes in heart transplantation: A quality metric for the modern era
Bakhtiyar, S. S., Sakowitz, S., Ali, K., Coaston, T. N., Verma, A., Chervu, N. L., & Benharash, P. (2023) · Surgery · doi:10.1016/j.surg.2023.03.014 · Cited by 8
EASD, E. (2013) · Kardiologia Polska · doi:10.5603/kp.2013.0289 · Cited by 9
Twenty-Year Experience of Heart Transplantation: Early and Long-Term Results
Lee, J. H., Yeom, S. Y., Hwang, H. Y., Choi, J.-W., Cho, H., Lee, H., Huh, J.-H., & Kim, K. (2016) · The Korean Journal of Thoracic and Cardiovascular Surgery · doi:10.5090/kjtcs.2016.49.4.242 · Cited by 8
“Additional factors such as previous sternotomy, body mass index, donor sex, race, smoking, and hypertension or diabetes mellitus of recipient were also known to significantly influence overall survival [9-13].”
Stahel, H. T. T., Unger, D., Schmidli, J., Gahl, B., Englberger, L., Kadner, A., Eberle, B., Mohaçsi, P., & Carrel, T. P. (2014) · Frontiers in Surgery · doi:10.3389/fsurg.2014.00046 · Cited by 8
Heart Transplant Outcomes in Patients With Pretransplant Diabetes Mellitus
Jalowiec, A., Grady, K. L., & White‐Williams, C. (2017) · American Journal of Critical Care · doi:10.4037/ajcc2017571 · Cited by 7
Weidner, G., Hemmersbach, M., Smits, J. M., Kubiak, T., Schulz, U., Gummert, J. F., Weyand, M., & Spaderna, H. (2013) · Diabetes Care · doi:10.2337/dc12-1725 · Cited by 7
“Whether patients with advancedheart failure and diabetes melli-tus (DM) should be listed for heart transplantation (HTx) remains controversial due to conflicting findings regarding their post-HTx survival (1–3).”
BackgroundInfluentialDoes Lung Donation by Heart Donors Have an Impact on Survival in Heart Transplant Recipients?
Yu, X., Friedmann, P., Bello, R. A., Goldstein, D. Y., & D’Alessandro, D. A. (2016) · American Journal of Transplantation · doi:10.1111/ajt.13981 · Cited by 7
Anesthesia for Heart Transplantation
Ramsingh, D. S., Harvey, R. E., Runyon, A., & Benggon, M. (2017) · Anesthesiology Clinics · doi:10.1016/j.anclin.2017.05.002 · Cited by 7
Taherkhani, N., Sepehri, M. M., Khasha, R., & Shafaghi, S. (2021) · Transplantation · doi:10.1097/tp.0000000000003623 · Cited by 6
Suarez‐Pierre, A., Zakrzewski, J., Anigbogu, C., Iguidbashian, J., Ziogas, I. A., Peters, L. L., Ambardekar, A. V., Hoffman, J. R. H., Reece, T. B., Cleveland, J. C., et al. (2023) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2023.10.052 · Cited by 6
Elevated donor hemoglobin A1c does not impair early survival in cardiac transplant recipients
Joseph, J. T., Mulvihill, M. S., Yerokun, B. A., Bell, S. M., Milano, C. A., & Hartwig, M. G. (2017) · Clinical Transplantation · doi:10.1111/ctr.12995 · Cited by 6
Rotary Blood Pumps As Definitive Treatment for Severe Heart Failure
Westaby, S. (2013) · Future Cardiology · doi:10.2217/fca.12.89 · Cited by 5
CODUSA - Customize Optimal Donor Using Simulated Annealing In Heart Transplantation
Ansari, D., Andersson, B., Ohlsson, M., Höglund, P., Andersson, R. E., & Nilsson, J. (2013) · Scientific Reports · doi:10.1038/srep01922 · Cited by 5
DURABLE MECHANICAL CIRCULATION SUPPORT AS AN ALTERNATIVE TO HEART TRANSPLANTATION
Gautier, S. V., Itkin, G. P., Шевченко, А. О., Абдулнаимович, Х. Т., & Козлов, В. А. (2016) · Russian Journal of Transplantology and Artificial Organs · doi:10.15825/1995-1191-2016-3-128-136 · Cited by 5
“Кilic с соавторами [13] на большой группе больных (свыше 9 тыс.”
Hong, Y., Hess, N. R., Ziegler, L. A., Hickey, G., Huston, J., Mathier, M. A., McNamara, D. M., Keebler, M., Gómez, H., & Kaczorowski, D. J. (2023) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2023.07.012 · Cited by 5
Heart transplantation vs long-term mechanical assist devices: clinical equipoise?
Shumway, S. J. (2013) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezt210 · Cited by 5
“In a recent review, 10-year survival in heart transplant recipients was associated with age <55, white race, younger age of the donor, and shorter organ ischaemia times [14].”
BackgroundHong, Y., Huckaby, L. V., Hess, N. R., Ziegler, L. A., Hickey, G., Huston, J., Mathier, M. A., McNamara, D. M., Keebler, M., & Kaczorowski, D. J. (2024) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2024.01.010 · Cited by 5
Risk of recipient age on 1‐year mortality after simultaneous heart–lung transplantation
Kwon, J. H., Hardy, W. A., Shorbaji, K., Huckaby, L. V., Welch, B. A., Hashmi, Z. A., Gibney, B. C., Bostock, I. C., & Kilic, A. (2022) · Journal of Cardiac Surgery · doi:10.1111/jocs.17009 · Cited by 4
“The inferior survival among older recipients of isolated heart and isolated lung transplantation has been attributed to age‐related declines in immune and renal function, leading to increased rates of infection and postoperative renal failure in these patients, compared to their younger counterparts.(6,12,13) An age‐a…”
ResultCarrier, M., & Perrault, L. P. (2014) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2014.06.024 · Cited by 4
Iyanna, N., Nasim, U., Dorken‐Gallastegi, A., Hess, N. R., Abdullah, M., Hickey, G., Keebler, M., Horn, E. T., Hong, Y., & Kaczorowski, D. J. (2024) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2024.11.024 · Cited by 3
Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation
Hong, Y., Hess, N. R., Dorken‐Gallastegi, A., Abdullah, M., Iyanna, N., Nasim, U., Sultan, I. S., Hickey, G., Keebler, M., & Kaczorowski, D. J. (2025) · Clinical Transplantation · doi:10.1111/ctr.70093 · Cited by 3
Hong, Y., Nasim, U., Dorken‐Gallastegi, A., Iyanna, N., Woolley, B. E., Machinski, S. N., Hickey, G., Keebler, M., Horn, E. T., & Kaczorowski, D. J. (2025) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2025.09.019 · Cited by 3
Precision QALYs, Precisely Unjust
Fleck, L. M. (2019) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180119000367 · Cited by 3
Race/Ethnic Disparities in Cardiac Transplantation
Nayak, A., Cole, R., & Morris, A. (2019) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-019-0629-6 · Cited by 3
Modern ideas in heart donor selection criteria
Tenchurina, E. A., & Minina, M. G. (2020) · Russian Journal of Transplantology and Artificial Organs · doi:10.15825/1995-1191-2020-3-174-181 · Cited by 3
“Хорошо известно, что молодой возраст донора является доказанным фактором, имеющим положительное влияние на выживаемость реципиентов сердца [33].”
Hong, Y., Hess, N. R., Ziegler, L. A., Dorken‐Gallastegi, A., Iyanna, N., Abdullah, M., Horn, E. T., Mathier, M. A., Keebler, M., Hickey, G., et al. (2024) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2024.09.018 · Cited by 2
Thriving Long Term After Heart Transplantation
Alkhalaileh, F., Duarte, G., & Baran, D. A. (2025) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2025.11.014 · Cited by 2
Metadata
- Authors
- Kilic, A., Weiss, E. S., George, T. J., Arnaoutakis, G. J., Yuh, D. D., Shah, A. S., & Conte, J. V.
- Affiliations
- Johns Hopkins University (US)
- Johns Hopkins Hospital (US)
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 93
- Issue
- 3
- Pages
- 699-704
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2042384239
- Cited by
- 131
- References
- 25
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 10 · 2023: 9 · 2022: 6 · 2021: 4 · 2020: 13 · 2019: 8 · 2018: 3 · 2017: 8 · 2016: 11 · 2015: 7 · 2014: 14 · 2013: 17 · 2012: 4
- FWCI
- 13.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- heart transplantation, long-term survival, transplant recipient characteristics, donor age, donor ischemic time, transplant center volume, mechanical ventilation, diabetes mellitus, race, age, mortality risk factors, United Network for Organ Sharing registry, organ allocation policy, organ shortage, organ procurement, organ donation
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Time Factors, Survival Rate, Case-Control Studies, Heart Transplantation, Survivors
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