Spanish Heart Transplant Registry. 28th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2016)

INTRODUCTION AND OBJECTIVES

The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984.

METHODS

We summarize the main features of recipients, donors, surgical procedures, and outcomes of all cardiac transplants performed in Spain up to December 31, 2016.

RESULTS

A total of 281 cardiac transplants were performed in 2016. The whole historical series consisted of 7869 procedures. The main features of transplant procedures in 2016 were similar to those observed in recent years. A high percentage of procedures were urgent, particularly those with use of pretransplant continuous-flow left ventricular assist devices (19.1% of all transplants). Survival significantly improved in the last decade compared with previous periods.

CONCLUSIONS

During the last few years, transplant activity in Spain has remained steady, with approximately 250-300 transplants/year. Despite a more complex clinical context, survival has improved in recent years.

Spanish Heart Transplantation Registry. 27th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2015)

INTRODUCTION AND OBJECTIVES

The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984.

METHODS

We describe the main features of recipients, donors, surgical procedures, and results of all heart transplants performed in Spain until December 31, 2015.

RESULTS

A total of 299 cardiac transplants were performed in 2015, with the whole series comprising 7588 procedures. The main transplant features in 2015 were similar to those observed in recent years. A remarkably high percentage of transplants were performed under emergency conditions and there was widespread use of circulatory assist devices, particularly continuous-flow left ventricular assist devices prior to transplant (16% of all transplants). Survival has significantly improved in the last decade compared with previous time periods.

CONCLUSIONS

During the last few years, between 250 and 300 heart transplants have consistently been performed each year in Spain. Despite a more complex clinical context, survival has increased in recent years.

Spanish Heart Transplantation Registry. 26th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2014)

INTRODUCTION AND OBJECTIVES

We present the characteristics and outcomes of heart transplantation in Spain since it was first performed in 1984.

METHODS

A descriptive analysis of the characteristics of recipients, donors, the surgical procedure, and the outcomes of heart transplantations performed in Spain until 31 December 2014.

RESULTS

In 2014, 266 procedures were performed, making a time series of 7289 transplantations. The temporal analysis confirmed a significant worsening of the clinical profile of recipients (higher percentage of older patients, patients with severe renal failure, insulin-dependent diabetes, previous cardiac surgery, and previous mechanical ventilation), of donors (higher percentage of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations, reaching 41.4% in 2014, and ischemia time>240min). Mechanical assist devices were used less than in 2013; in 2014 they were used in 18.8% of all transplant recipients. Survival at 1, 5, 10, and 15 years was 76%, 65%, 52%, and 38%, respectively, and has remained stable since 1995.

CONCLUSIONS

Cardiac transplantation activity in Spain has remained stable in recent years, at around 250 procedures per year. Despite a clear deterioration in donor and recipient characteristics and surgical times, the mortality outcomes have remained comparable to those of previous periods in our environment. The growing use of circulatory assist devices before transplantation is also confirmed.

Spanish Heart Transplantation Registry. 25th official report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2013)

INTRODUCTION AND OBJECTIVES

The present article reports the characteristics and outcome of heart transplantation in Spain since it was first performed in May 1984.

METHODS

We provide a descriptive analysis of the characteristics of the recipients, the donors, the surgical procedure, and results of the heart transplantations performed in Spain until 31 December 2013.

RESULTS

During 2013, a total of 248 transplantation procedures were carried out, bringing the time series to a total of 7023 transplantations. The temporal analysis confirms a significant deterioration in the clinical profile of the recipients (higher percentage of older patients, severe renal failure, insulin-dependent diabetes mellitus, previous heart surgery, mechanical ventilation), of the donors (higher proportion of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations which, in 2013, reached 49%, and with ischemia times > 240min). There was a marked increase in the use of circulatory assist devices prior to transplantation which, in 2013, were employed in 25.2% of all the patients. The survivals at 1, 5, 10, and 15 years were 76%, 65%, 52%, and 37%, respectively, and have remained stable since 1995.

CONCLUSIONS

Heart transplantation activity in Spain remains stable in recent years, with around 250 procedures a year. Despite the clear deterioration in the clinical characteristics of the donors and recipients, and lengthening of the operative times, the results in terms of mortality continue to be comparable to those reported in our neighboring countries, and a growing use of circulatory assist devices prior to transplantation is confirmed.

Spanish Heart Transplantation Registry. 24th official report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2012)

INTRODUCTION AND OBJECTIVES

The present article reports the characteristics and results of heart transplantation in Spain since this therapeutic modality was first used in May 1984.

METHODS

We summarize the main features of recipients, donors, and surgical procedures, as well as the results of all heart transplantations performed in Spain until December 31, 2012.

RESULTS

A total of 247 heart transplantations were performed in 2012. The whole series consisted of 6775 procedures. Recent years have seen a progressive worsening in the clinical characteristics of recipients (34% aged over 60 years, 22% with severe kidney failure, 17% with insulin-dependent diabetes, 29% with previous heart surgery, 16% under mechanical ventilation) and donors (38% aged over 45 years, 26% with recipient: donor weight mismatch>20%), and in surgical conditions (29% of procedures at >4 h ischemia and 36% as emergency transplantations). The probability of survival at 1, 5, 10, and 15 years of follow-up was 78%, 67%, 53%, and 38%, respectively. These results have remained stable since 1995.

CONCLUSIONS

In recent years, the number of heart transplantations/year in Spain has remained stable at around 250. Despite the worsening of recipient and donor clinical characteristics and of time-to-surgery, the results in terms of mortality have remained stable and compare favorably with those of other countries.

Spanish Heart Transplantation Registry. 21st Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2009)

INTRODUCTION AND OBJECTIVES

The purpose of this report is to present the results obtained with heart transplantation in Spain from the first use of this therapeutic modality in May 1984.

METHODS

A descriptive analysis of all heart transplantations performed up to December 31, 2009 is presented.

RESULTS

In total, 6048 transplants were carried out. The typical clinical profile of a Spanish heart transplant patient in 2009 was that of a 53-year-old male who had been diagnosed with nonrevascularizable ischemic heart disease and who had severely impaired ventricular function and a poor functional status. The implanted heart typically came from a donor who had died from a brain hemorrhage (mean age 37 years) and the average time on the waiting list was 106 days. Mean survival time has increased progressively over the years. Whereas for the whole time series, the probability of survival at 1, 5, 10 and 15 years was 78%, 67%, 53% and 40%, respectively, for the past 5 years, the probability of survival at 1 and 5 years was 85% and 73%, respectively. The most frequent cause of death was acute graft failure (17%), followed by infection (16%), the combination of graft vascular disease and sudden death (14%), tumor (12%) and acute rejection (8%).

CONCLUSIONS

The survival rates obtained in Spain with heart transplantation, especially in recent years, make the procedure the treatment of choice for patients who have irreversible heart failure and a poor functional status and for whom there are few other established medical or surgical options.

Spanish Heart Transplantation Registry. 20th official report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2008)

INTRODUCTION AND OBJECTIVES

The purpose of this article was to present the results of the heart transplantations carried out in Spain from the first use of this therapeutic modality in May 1984.

METHODS

A descriptive analysis of all heart transplantations performed up until December 31, 2008 was carried out.

RESULTS

In total, 5774 transplantations were performed. The typical clinical profile of a Spanish heart transplant patient in 2008 was that of a 53-year-old male who had been diagnosed with nonrevascularizable ischemic heart disease and who had severely depressed ventricular function and a poor functional status. The implanted heart typically came from a 37-year-old donor who had died from a head injury or brain hemorrhage and the average waiting time was 111 days. The mean survival time has increased progressively over the years. Whereas the probability of survival at 1, 5, 10 and 15 years for the whole patient series was 77%, 66%, 53% and 40%, respectively, the probability of survival at 1 and 5 years for patients seen in the last 5 years was 80% and 70%, respectively. The most frequent cause of death was infection (17%), followed by the combination of graft vascular disease and sudden death (15%), acute graft failure (13%), tumors (12%), and acute rejection (6%).

CONCLUSIONS

The survival rate obtained with heart transplantation in Spain, especially in recent years, has made transplantation the treatment of choice for patients with end-stage heart failure and a poor functional status and for whom there are few other established medical or surgical options.

[Indications and long-term outcomes for solid organ transplant. Quality of life in solid organ transplant recipients]

Organ transplant constitutes one of the most encouraging advances in the history of the medicine. The organ transplants that were a distant challenge in the seventies currently are a routine procedure in the medical practice that has contributed to extending survival and quality of life in the general population. Spain has reached the highest rate for donation and transplants per one million inhabitants worldwide, this extraordinary health care work being a combined achievement of Spanish Health Care System. The objective of this article is to review the indications of solid organ transplants and their long-term outcomes, evaluating the impact on the health-related quality of life in solid organ transplant recipients.