Patient-Related Preoperative Clinical Factors Influencing 1-Year Survival After Orthotopic Heart Transplantation – A Single Center Polish Experience

BACKGROUND: End-stage heart failure is a growing problem in Poland. Orthotopic heart transplantation remains the best treatment option. Although increasing, the number of heart transplants is disproportionately low compared with patient need. Therefore, it is crucial to identify factors contributing to improvement of heart transplantation outcomes. To find factors providing best survival and optimal recipient selection, we analyzed pretransplant patient-related clinical factors. MATERIAL/METHODS: Between May 2015 and May 2020, we performed 258 cardiac transplants at our institution. We reviewed possible patient-related clinical factors affecting the 1-year survival of our patients and analyzed factors related to survival. Mean age at transplant was 53.5 (±11.8) years; 22.9% of patients were women. Preoperative factors were analyzed using univariable and multivariable analyses. RESULTS: In this cohort, 31.8% were diabetic, 43% had ischemic etiology of heart failure, and 15.3% had reversible pulmonary hypertension. Mechanical circulatory support was used in 22%. During 1-year observation, 64 (24.8%) patients died. Univariable analysis showed ischemic etiology (hazard ratio [HR]=2.05, CI=1.227–3.429; P=0.01) and left ventricular assist device were associated with 1-year risk of death (HR=1.953, CI=1.090–3.499; P=0.02). Urgent listing trended toward worsened prognosis (HR=1.509, CI=0.95–2.397; P=0.08). Multivariable analysis showed ischemic etiology (HR=1.81, CI=1.075–3.059; P=0.03), total mechanical circulatory support (HR=1.93, CI=1.080–3.437; P=0.03), decreased eGFR (HR=0.987, CI=0.975–0.998; P=0.03), and protein level (HR=0.97, CI=0.951–0.998; P=0.04) were independently associated with worse 1-year survival after transplantation. CONCLUSIONS: Ischemic etiology and mechanical circulatory support were the most important preoperative factors. Malnutrition and renal failure were additional risk factors. Age alone did not influence 1-year survival.