A retrospective cohort analysis of 1205 heart transplant recipients managed with a standardized institutional protocol

Background: Heart transplantation continues to be a vital treatment for end-stage heart failure, although outcomes can vary widely across different regions and healthcare systems. This study evaluates the outcomes of a large-scale heart transplantation program under the standardized institutional protocol. Materials and Methods: From September 2008 to December 2024, a total of 1205 patients underwent heart transplantation at our Hospital using the standardized institutional protocol. Surgical volume, survival rates, and the impact of cold ischemia time (CIT), donor–recipient weight ratio (DRWR), mechanical support, and complications on survival were analyzed. Results: Pediatric patients demonstrated 30-day, 1-year, 3-year, 5-year, and 10-year survival rates of 95%, 90%, 86%, 81%, and 74%, respectively, while adult survival rates were 92%, 85%, 83%, 81%, and 74%, respectively. There was no difference in survival between the groups with different cold ischemia time or DRWR greater than or less than 1.2 in both the pediatric and adult groups ( P >0.05). Neither prolonged CIT (≥6 h) nor extreme DRWR (<0.8 or >2.5) was associated with excess mortality ( P >0.05). Preoperative and postoperative mechanical support independently predicted higher mortality (hazard ratio 1.88, 95% confidence interval 1.42–2.50; P <0.001). Pediatric patients had longer intensive care unit stays (median [interquartile range] 226 [137–446] vs 216 [141–341] h). Although their median ventilation time was shorter (1680 [1245–5214] vs 2081 [1260–3660] min), the mean duration was longer than in adults. Postoperative echocardiography showed a significant increase in left ventricular ejection fraction and marked reductions in the sizes of both atria and ventricles. In the pediatric group, complications had no impact on survival ( P >0.05), while in adults they significantly decreased survival ( P <0.05). Conclusion: This standardized institutional protocol effectively improves heart transplant survival, providing valuable insights for optimizing transplant practices.