TY - JOUR
T1 - Long-term Survival After Heart Transplantation
T2 - A Population-based Nested Case-Control Study
AU - Suarez-Pierre, Alejandro
AU - Lui, Cecillia
AU - Zhou, Xun
AU - Giuliano, Katherine
AU - Stevens, Kent
AU - Almaraz-Espinoza, Alejandro
AU - Crawford, Todd C.
AU - Fraser, Charles D.
AU - Whitman, Glenn J.
AU - Choi, Chun W.
AU - Higgins, Robert S.
AU - Kilic, Ahmet
N1 - Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. This content is the responsibility of the authors alone and does not necessarily reflect the view or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. This study uses data obtained from the public-use file of the National Longitudinal Mortality Study. The views expressed in this paper are those of the authors and do not necessarily reflect the view of the National Longitudinal Mortality Study, the Bureau of the Consensus, or the project sponsors: the National Heart, Lung, and Blood Institute , the National Cancer Institute , the National Institute on Aging , and the National Center for Health Statistics .
Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. This content is the responsibility of the authors alone and does not necessarily reflect the view or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. This study uses data obtained from the public-use file of the National Longitudinal Mortality Study. The views expressed in this paper are those of the authors and do not necessarily reflect the view of the National Longitudinal Mortality Study, the Bureau of the Consensus, or the project sponsors: the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Aging, and the National Center for Health Statistics.
Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/3
Y1 - 2021/3
N2 - Background: Heart transplantation is the mainstay of treatment for patients in end-stage heart failure. This study sought to contrast survival after transplantation with that of the general population to quantify standardized mortality rates using a nested case-control study design. Methods: Control subjects were noninstitutionalized inhabitants of the United States identified through the National Longitudinal Mortality study. Case subjects were adults who underwent heart transplantation between 1990 and 2007 and identified through the Organ Procurement and Transplantation Network. Propensity-matching (5:1, nearest neighbor, caliper = 0.1) was utilized to identify suitable control subjects based on age, sex, race, and state of permanent residency. The primary study endpoint was 10-year survival. Results: In all, 31,883 heart transplant recipients were matched to 159,415 noninstitutionalized residents of the United States. The 10-year survival of heart transplant recipients was 53%. The population expected mortality rate was 15.9 deaths per 100 person-years with an observed rate of 45.1 deaths per 100 person-years (standardized mortality rate [SMR] 2.84; 95% confidence interval, 2.82 to 2.87). The broadest gaps between observed and expected survival were evident in female (SMR 3.63), black (SMR 3.67), and Hispanic (SMR 4.12) recipients. Standardized mortality ratios declined over time (1990 to 1995, 3.09; 1996 to 2000, 2.90; 2001 to 2007, 2.58). The long-term standardized survival of older recipients was closest to that expected for their age. Conclusions: Heart transplant recipients have considerable long-term survival and have a threefold higher standardized long-term mortality rate than that of the noninstitutionalized population. Long-term mortality rates have consistently declined over time and will likely continue to decrease.
AB - Background: Heart transplantation is the mainstay of treatment for patients in end-stage heart failure. This study sought to contrast survival after transplantation with that of the general population to quantify standardized mortality rates using a nested case-control study design. Methods: Control subjects were noninstitutionalized inhabitants of the United States identified through the National Longitudinal Mortality study. Case subjects were adults who underwent heart transplantation between 1990 and 2007 and identified through the Organ Procurement and Transplantation Network. Propensity-matching (5:1, nearest neighbor, caliper = 0.1) was utilized to identify suitable control subjects based on age, sex, race, and state of permanent residency. The primary study endpoint was 10-year survival. Results: In all, 31,883 heart transplant recipients were matched to 159,415 noninstitutionalized residents of the United States. The 10-year survival of heart transplant recipients was 53%. The population expected mortality rate was 15.9 deaths per 100 person-years with an observed rate of 45.1 deaths per 100 person-years (standardized mortality rate [SMR] 2.84; 95% confidence interval, 2.82 to 2.87). The broadest gaps between observed and expected survival were evident in female (SMR 3.63), black (SMR 3.67), and Hispanic (SMR 4.12) recipients. Standardized mortality ratios declined over time (1990 to 1995, 3.09; 1996 to 2000, 2.90; 2001 to 2007, 2.58). The long-term standardized survival of older recipients was closest to that expected for their age. Conclusions: Heart transplant recipients have considerable long-term survival and have a threefold higher standardized long-term mortality rate than that of the noninstitutionalized population. Long-term mortality rates have consistently declined over time and will likely continue to decrease.
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U2 - 10.1016/j.athoracsur.2020.05.163
DO - 10.1016/j.athoracsur.2020.05.163
M3 - Article
C2 - 32739258
AN - SCOPUS:85099804550
SN - 0003-4975
VL - 111
SP - 889
EP - 898
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -