--- A comprehensive retrospective cohort study on heart transplantation: Exploring complications, mortality Causes, and survival rates

Abstract

Background: Heart transplantation has emerged as the preferred treatment for selected individuals with advanced heart failure. However, the outcomes and complications of this procedure have not been evaluated thoroughly among the Iranian population. In the present study, we aimed to provide a comprehensive understanding of the epidemiological characteristics of patients who had HT, with a focus on indications for HT, early and late complications, mortality causes, and survival rate.

Methods: In this retrospective cohort study, we included all patients aged ³18 years who underwent HT from July 2013 up to June 2023 at academic hospitals at Shiraz University of Medical Sciences. A questionnaire of several variables was completed for each patient by reviewing medical records. The following outcomes were collected for the first 10 years after HT surgery: (1) mortality/survival: the incidence of death, cause of death, and length of survival; (2) rejection: the incidence of rejection, time, and type of rejection; and (3) the incidence of early and late post-transplant complications. 1-year, 2-year, and 10-year survival was reported using Kaplan-Meier method. Multivariate relation with survival was evaluated by Cox regression analysis.

Results: 75 patients underwent Heart Transplant operation, among which, 48 were male and 27 were female. The most common underlying cause of Heart Transplant was dilated Cardiomyopathy accounting for 85.3% of surgeries. Following the surgery, fifteen (23.8%) patients had evidence of transplant rejection. Overall mortality was 29 deaths, 19 of which were male and 10 were female. Twelve patients (15.8%) died in the operating room and the overall survival of our patients was 129.41±14.94 months. By excluding the 12 in-OR expired patients, the survival rates at 1 year, 2 years, and 10 years improved to 80.7%, 71.1%, and 68.3%, respectively.

Conclusions: Overall, the findings of this study provide valuable insights into the demographic and clinical characteristics of patients who undergo HT, as well as their post-transplant outcomes. Additionally, our findings will contribute to the current body of knowledge on pre-heart transplant risk assessment and patient selection, as well as early post-heart transplant diagnosis and management of significant complications.