According to a March 2, 2012 report from Johns Hopkins University, persons receiving a heart transplant before age 55 and from a center that performs at least 9 heart transplants per year are more likely to survive 10 years after the transplant. The report was published in the March issue of the Annals for Thoracic Surgery.
Researchers at Johns Hopkins analyzed all data collected by the United Network for Sharing. UNOS provided documentation and records covering 22,000 adults from the U.S. who received a heart transplant between 1987 and 1999. After 10 years, approximately half of all patients were still alive. Under close examination, researchers identified specific factors that contributed to the 10-year lifespan benchmark.
Dr. Arman Kilic, a surgical resident at Johns Hopkins, led the study. “There are 2000 to 2500 heart transplants per year in the US. Many people die waiting for an organ. We have to be very smart about how to allocate scarce organs, and our research suggests we can predict which patients will live longer with the new heart.”
From the UNOS data, 9408 for heart transplant recipients lived for 10 years or more. In comparison, 10,370 for a heart transplant recipients did not live 10 years. About 3000 patients are unable to be contacted.
Johns Hopkins concluded that heart transplant recipients from centers that performed nine or more heart transplants per year at 31 percent greater chance of 10-year survival than those patients who receive hearts in facilities that perform less than 9 heart transplants per year. This explains why low volume centers are closing the doors and referring heart transplant patients to larger centers. The trend is noticeable.
Importantly, patients who received a heart transplant at the age 55 or younger had a 25% better chance of surviving 10 years than patients who received heart transplants over the age of 55. Furthermore, Caucasian heart transplant recipients are 35% more likely to survive 10 years than minority heart transplant recipients
Dr. Kilic also revealed that approximately half the patients in the study were more than 55 years of age. The report is likely to fuel the debate about how old is too old to receive a heart transplant. Currently, the maximum age to be accepted in a heart transplant center varies from 65-70, depending upon the center’s own standards. This is an issue that has caught the eye of Congress, where there is debate about not only the most appropriate age limit reception of a heart transplant but also about the entire organ award program.
The report concludes that the higher survival rate at active heart transplant centers is not only attributable to more experienced heart transplant surgeons but also to more experienced pre-transplant cardiology staffs and experienced caregivers during recovery. The complex post-operative care has a direct impact on the life span of transplant recipients.
Disturbingly, the report indicates that patients, who were on ventilators prior to transplant, are 47 percent more likely to die within 10 years of the surgery than patients who were not on ventilation. The general tone indicates that patients on ventilators before transplant are not good candidates for transplantation. The research team also revealed that patients who are diabetic before transplant or 33% more likely than not survive the 10 year benchmark.
The study definitely establishes that the impact on long-term survival is directly proportionate to the amount of time the donated heart is out of the body as it travels from donor to recipient. This is called ischemic time. Dr. Kilic reported that for each ischemic hour, the recipient’s chance of 10-year survival decreases by 11 percent.
Additionally, the donor’s age has a distinct bearing upon the longevity of the heart recipient. For every ten years younger the donor is, the recipient’s long-term survival rate increases by 10 percent. Under the current UNOS policy, hearts are awarded, regardless of age, to the sickest patients first. Many of these patients have less than one month to live. Kilic draws short of challenging the existing UNOS award policy but did suggest that in addition to identifying the sickest patients there should also be consideration for who will live longest with the new heart.
In the US alone, more than 5 million people experience heart failure every year. While lifestyle changes can reduce the symptoms and greatly reduce the number of incidents, heart transplantation is the survival standard for patients with unsustainable ejection fractions (EFTs). However, the system is over-crowded and hence only provides organs to patients with ejection fractions below 10 percent.
“These data could be used for both prognosis and allocation purposes. They help predict which patients have the best chance to derive the longest and most sustainable benefit from the limited number of hearts that become available each year. It also identifies areas that need further research, such as why racial disparities exist in long-term survival following heart transplant,” concluded Kilic.