Spanish Heart Transplantation Registry. 18th official report of the Spanish Society of Cardiology Working Group on heart failure, heart transplantation and associated therapies (1984-2006)

Introduction and objectives. The purpose of this article was to report the results of heart transplantations (HTs) carried out in Spain from the first use of the technique until December 2006. Methods. A descriptive analysis of all HTs carried out since the first transplant in May 1984 up to December 31, 2006. Results. In total, 5241 transplants have been performed. The majority (94%) were de novo transplants in adults. The percentages of pediatric transplants and retransplants were low, at 4% and 2%, respectively. The percentage of transplants that were combined with lung, kidney or pancreas transplants was also low (2%). The typical clinical profile of a Spanish heart transplant recipient was that of a 52-year-old male who had been diagnosed with nonrevascularizable ischemic heart disease along with severely depressed ventricular function and a poor functional status. The implanted heart was typically from a 34-year-old donor who had died from a head injury. The average waiting time was 125 days. The mean survival time has increased progressively over the years. Whereas for the whole series, the probabilities of survival at 1, 5, 10 and 15 years were 75%, 64%, 51 % and 35%, respectively, over the past 5 years, the probabilities of survival at 1 and 5 years were 80% and 75%, respectively. The most frequent cause of death was infection (21 %), followed by acute graft failure (18%), the combination of graft vascular disease and sudden death (13%), tumors (10%) and acute rejection (8%). Conclusions. The survival rates obtained in Spain with HT, especially in recent years, ensure that HT is the treatment of choice for patients with end-stage heart failure and a poor functional status. There are no other well-established medical or surgical alternatives.