Heart transplant experience of an Argentine institution lacking long-term assist devices

Introduction Heart transplantation (HT) is the standard treatment for patients with advanced heart failure. However, there is a global disparity between the number of patients on the waiting list and the availability of donors. Strategies such as donation after circulatory death and heart preservation devices could increase supply but are not available in Argentina. This forces us to transplant critically ill patients and to relax some contraindications. Objectives Primary: To evaluate the characteristics of transplant recipients and their mortality. Secondary:To assess the clinical evolution of transplanted patients over time. To analyze the characteristics and survival of patients based on Wood units (UW). Methods A retrospective cohort study was conducted, including patients over 18 years old who received an HT from January 2012 to December 2023. Patients with missing information were excluded. Mortality was evaluated up to one year post-transplant. Patients were divided into three cohorts based on the year of transplantation: 2012-2015, 2016-2019, and 2020-2023. Patients were compared based on whether they had less than 3 UW or higher values at the time of entering the waiting list. A consecutive sampling technique was applied, and statistical analyses were performed using Student's t-test, Wilcoxon test, and Fisher's exact test, with p < 0.05 considered significant. Results A total of 343 patients were included, with a median age of 53 years (IQR 43-61) and 73.8% male. The median UW was 2.6 (IQR 1.9-3.4). The clinical status on the waiting list was distributed as follows: elective 35 individuals (10.2%), urgent 159 (46.4%), and emergent 149 (43.4%). The mortality rate was 17.2% at 30 days (n=59), 6.4% at 180 days (n=18), and 2.3% at one year (n=6). In the 2020-2023 cohort, there was an increase in urgent and emergent transplants compared to previous cohorts (p < 0.001), along with a higher usage of ventricular assit devices (p = 0.001) (Figure 1), although no differences in mortality were found. 128 patients were transplanted with ≥ 3 UW; 95.3% were on the urgent or emergent waiting list, with no significant differences in mortality. Conclusions Heart transplantation is an accepted treatment for advanced heart failure, but the shortage of donors poses a global challenge. The lack of strategies to increase donation forces the relaxation of contraindications. In this context, having ≥ 3 UW in right heart catheterization upon entering the transplant list was not associated with increased mortality. These findings highlight the need for local strategies to improve transplant outcomes in Argentina.