Korean Circ J.  2019 Aug;49(8):724-737. 10.4070/kcj.2018.0392.

The Korean Organ Transplant Registry (KOTRY): Second Official Adult Heart Transplant Report

• Kim D
• Choi JO
• Oh J
• Cho HJ
• Jung SH
• Lee HY
• Kang SM
• Kim JJ
• Jeon ES

• KMID: 2456867
• DOI: http://doi.org/10.4070/kcj.2018.0392

Abstract

BACKGROUND AND OBJECTIVES
This second adult heart transplantation (HTx) report is based on Korean Organ Transplant Registry data submitted on 400 HTxs in recipients of all ages.
METHODS
From March 2014 to December 2017, a total of 400 HTxs were performed at 4 major centers in Korea. We analyzed demographics and characteristics according to transplant years. Patterns of immunosuppression, allograft rejection, and survival after HTx were analyzed. Donor and recipient age were highlighted.
RESULTS
Some distinct differences in HTx statistics were noted. Mean donor age increased significantly in the most recent years compared to 2014-2015, while mean recipient age did not change. The proportion of patients on pre-transplant extracorporeal membrane oxygenation (ECMO) increased over time. One-year and intermediate-term survival was significantly worse in patients on pre-transplant ECMO compared to those without mechanical support. Over the years, tacrolimus has increased to become the most frequently used calcineurin inhibitor over cyclosporine, while the number of patients using steroids both at discharge and 1-year follow-up has declined. Age did not affect 1-year survival, but significantly affected intermediate-term survival.
CONCLUSIONS
From 2014 to 2017, centers were willing to accept older donors to address increasing organ shortages and more patients received transplant under ECMO care. Increasing age was a strong independent factor for intermediate-term survival, however, post-transplant comorbidities did not differ among age groups. Further studies with longer follow-up duration are needed to better understand age-related post-transplant prognosis.

Keyword

Heart transplantation; Heart failure; Registries

MeSH Terms

Adult*
Allografts
Calcineurin
Comorbidity
Cyclosporine
Demography
Extracorporeal Membrane Oxygenation
Follow-Up Studies
Heart Failure
Heart Transplantation
Heart*
Humans
Immunosuppression
Korea
Prognosis
Registries
Steroids
Tacrolimus
Tissue Donors
Transplants*
Calcineurin
Cyclosporine
Steroids
Tacrolimus

Figure

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  Figure 1 Kaplan-Meier (A) 1-year survival, and (B) long-term survival by diagnosis (cardiomyopathy, coronary artery disease, congenital diagnosis, retransplant, and valvular heart disease).

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  Figure 2 Kaplan-Meier analysis by pre-transplant durable mechanical circulatory support use (transplant March 2014–December 2017). LVAD vs. ECMO vs. NO LVAD/ECMO, inotropes vs. no inotropes. Comparison of (A) 1-year survival and (B) intermediate-term survival by pre-transplant durable mechanical circulatory support use. ECMO = extracorporeal membrane oxygenation; LVAD = left ventricular assisting device.

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  Figure 3 Kaplan-Meier survival by recipient age (transplant March 2014–May 2018). Comparison of (A) 1-year survival and (B) intermediate-term survival according to recipient age.

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  Figure 4 HR for conditional mortality by recipient age on multivariable proportional hazard regression (mortality within and after 1-year post-HTx). HR = hazard ratio; HTx = heart transplantation.

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  Figure 5 HR for conditional mortality by donor age (adult recipient) on multivariable proportional hazards regression (mortality within and after 1-year post-HTx). HR = hazard ratio; HTx = heart transplantation.

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