MORTALITY AFTER HEART TRANSPLANTATION. A DESCRIPTIVE STUDY OF EARLY AND LATE OUTCOMES IN A HIGH-VOLUME CARDIAC CENTER.

Heart transplantation (HTx) remains the gold-standard treatment for end-stage heart failure. Advances in surgical and perioperative management have improved survival, but mortality continues to be a major concern, both early and late after transplantation. Understanding when and why deaths occur is essential to refine strategies across the continuum of care. This study provides a descriptive analysis of mortality among HTx recipients at La Fe University and Polytechnic Hospital, focusing on early outcomes in 2024 and late deaths from previous transplant cohorts. We performed a retrospective descriptive study using institutional data. All adult HTx procedures performed in 2024 were reviewed for early mortality. Additionally, we analyzed all deaths occurring in 2024 among patients transplanted in previous years. Variables included timing and cause of death. Long-term survival data were extracted for transplants performed between 2015 and 2024. Causes of death were categorized as cardiac (graft failure or rejection), infectious, oncologic, or other. Data were analyzed descriptively. RESULTS A total of 45 adult HTx procedures were performed in 2024, with 3 early in-hospital deaths (6.7%). Two of these patients had required mechanical circulatory support at the time of transplant. In the same year, 14 patients transplanted in previous years died. The main causes of death in this group were: infection in 6 cases (42.9%), malignancy in 3 (21.4%), graft dysfunction in 2 (14.3%), and other causes in 3 (21.4%). Overall survival for transplants performed between 2015 and 2024 was 79.3% at 1 year, 74% at 5 years, and 64.7% at 8 years. These figures align with current international standards. DISCUSSION This analysis highlights the dual nature of mortality in HTx: early deaths often relate to perioperative challenges and critical preoperative status, while late deaths result from chronic complications such as rejection, infection, or malignancy. The anesthesiology team plays a pivotal role throughout the perioperative process, particularly in high-risk patients supported with mechanical assist devices. Their expertise is essential to ensure hemodynamic stability, optimize organ perfusion, and facilitate early recovery. Late mortality patterns emphasize the need for long-term coordination between transplant, cardiology, infectious disease, oncology, and critical care teams. Routine mortality review allows for the continuous improvement of protocols and patient care pathways. CONCLUSION Despite increasing complexity, heart transplantation at our center maintains favorable short- and long-term outcomes. Continuous multidisciplinary involvement, with anesthesiology at the core of perioperative care, is key to improving survival and reducing preventable mortality.