Heart transplantation in the United States 2004.

The limited availability of donated hearts is not sufficient to meet the needs of increasing numbers of heart transplant candidates. Thus, it is important to find the best recipient for each donated heart in order to achieve the best graft and patient survival. We investigated heart transplant outcomes in the US and the factors that influence them. We present information regarding 36,277 heart transplants reported to the OPTN/ UNOS Registry from January 1988-October 2004. The annual number of transplants ranged between 2,057-2,363 during the past 14 years and has not increased since 1990. One- and 5-year graft survival rates have gradually increased and have reached 87% and 72%, respectively, for adult recipients. Non-immunological factors, such as the circumstance of the donor's death, cause of death and ischemic time, the recipient's race, age, original disease, infection, systemic cerebro-vascular disease, whether or not they were on life support, renal function etc, significantly impacted on graft survival. Immunological factors, such as previous transfusion, previous transplantation, HLA mismatches, sensitization status, rejection episodes before discharge or within one year after transplant, were associated with lower graft survival rates. In conclusion, in order to achieve the best possible outcome for heart transplant patients, we must first find the most suitable candidate for an available donated heart; secondly, we must optimize immunosuppressive regimens and other medical and surgical therapies to prevent graft rejection and transplant-related complications.