NIV Congres

The use of induction therapy is different in the 3 Dutch heart transplant centres. One centre uses ATG per protocol and other centres IL-2 receptor antagonists only in case of moderate to severe kidney dysfunction in the intended recipients. We questioned whether these differences result in different outcomes after transplantation.

Follow-up data were obtained of 341 adult patients transplanted between 2002 and 2011 (Centre A: n=165, Centre B: n=158 and Centre C: n=18). We compared patient survival, treated rejection episodes, malignancies and kidney function. The outcome of 25 paediatric transplants was analysed separately. In the comparisons Centre C has been left out of consideration because of the low number of transplants and comparisons are between adult patients. For statistical analysis Chi square test, T-test, Kaplan Meier, Log Rank, and Cox regression were used.

Recipients were older in Centre A than in Centre B (p=0.03), mean age 49 yrs (±SD=10) vs 46 yrs (±SD=12). The distribution of primary heart disease was similar: coronary artery disease 35 vs 35%, cardiomyopathy 59 vs 57% and other disease 6 vs 8%. Survival after 5 years was 79% in adult patients without a difference between Centre A and Centre B (p=0.3); survival in centre C was comparable. In the paediatric group survival was 90% at 5 years. Centre A treated significantly more acute rejection episodes than Centre B (Hazard ratio = 9.7; 95%CI: 5,6 -16,8; p‹0.001) within the first year. Skin malignancies occurred in 11 and 6 patients in Centre A and Centre B respectively. Other malignancies occurred in respectively 7 and 7 patients. Higher serum creatinine levels were found in Centre A after the first and second year after transplantation: 153µmol/l vs 107µmol/l (p‹0.01) and 133µmol/l vs 105µmol/l (p‹0.05) respectively. Later on these levels were comparable.

Survival after heart transplantation in the Netherlands is better than reported by the International Society of Heart & Lung Transplantation and is the same in the older two centres. Dutch centres differ in the use of induction therapy. More rejection treatments are given in Centre A which do not result in more malignancies. After 1 and 2 years kidney function is worse in the Centre A. Creatinine levels equal Centre B levels later on. The differences found do not support the use of induction therapy and raise questions about the interpretation of endomyocardial biopsies and /or the treatment of rejection on hemodynamic changes only.