Comparaison de trois décades de transplantation cardiaque aux Cliniques Universitaires Saint-Luc

Details

Supervisors

Pouleur, Anne-Catherine

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine, à finalité spécialisée

Abstract

Objective: To compare the profile of heart transplant donor and recipient patients at CUSL over three decades to evaluate if these profiles have evolved over time and determine independent predictive factors for graft survival. Introduction: Heart transplantation remains the treatment of choice for end-stage heart failure refractory to medical therapy. However, due to the aging population and increasing cardiovascular risk factors, the global prevalence of heart failure keeps growing, resulting in a growing demand for heart transplants. To address this situation, donor selection criteria have been relaxed in recent years. At the same time, advances in medical and surgical therapies, and the development of cardiac assist devices, have prolonged the survival of patients with heart failure, leading to changes in the profile of heart transplant recipients. Despite these changes, the survival of transplant patients does not seem to be impacted, raising questions about the evolution of donor and recipient profiles and their impact on post-transplant mortality. Methods: This retrospective monocentric cohort study included 483 heart transplant patients at CUSL from 1985 to 2019, for a total of 464 heart transplants. After excluding patients who received cardiac assist devices, patients were divided into three groups: decade 1 (1985-1994; n = 184), decade 2 (1995-2006; n = 150), and decade 3 (2007-2019; n = 130). Results: The mean age of recipient patients remained stable over the decades, but there was a significant increase in the prevalence of pre-transplant comorbidities, including obesity (decade 1 vs 2 vs 3: 5.56% vs 13.9% vs 23.8%, p < 0.001) and diabetes (decade 1 vs 2 vs 3: 9.09% vs 8.33% vs 18.5%, p = 0.045). There was also a decrease in retransplantation (decade 1 vs 2 vs 3: 4.89% vs 10.0% vs 1.54%, p = 0.008) and diversification of indications for heart transplantation. Among donors, there was an increase in mean age (decade 1 vs 2 vs 3: 30.9 vs 35.8 vs 38.2, p < 0.001) and an increase in the prevalence of obesity (decade 1 vs 2 vs 3: 1.71% vs 7.33% vs 3.85%, p = 0.040). There was a decrease in the number of donors who died from traumatic brain injury (decade 1 vs 2 vs 3: 60.3% vs 33.3% vs 28.5%, p < 0.001) and an increase in unspecified causes of death, such as drug overdose or brain tumor (decade 1 vs 2 vs 3: 6.52% vs 22.0% vs 35.4%, p < 0.001). Furthermore, the use of tacrolimus increased at the expense of cyclosporine (decade 2 vs 3: 32.8% vs 78.9%, p.2 vs 3 < 0.001). A significant improvement in overall graft survival was demonstrated, with independent predictive factors being recipient age at transplantation (HR 1.02 [1.00-1.04], p = 0.041) and the time period corresponding to the third decade (HR 0.602 [0.362-1.00], p = 0.049). Conclusion: Over the past few decades, there has been an evolution in the profiles of heart transplant donors and recipients, with an increasing prevalence of numerous cardiovascular risk factors in both groups. Despite this evolution, there has been an improvement in the prognosis and survival of transplant patients at CUSL in recent years. It appears that the improvement in graft survival over the years can be attributed to specific advancements that have occurred during the third decade, which were not identified in this study.