Atli Steinn Valgarðsson¹

Þórdís Jóna Hrafnkelsdóttir^2,3

Tómas Þór Kristjánsson^1,3

Hildigunnur Friðjónsdóttir⁴

Kristinn Sigvaldason^3,5

Göran Dellgren⁶

Tómas Guðbjartsson^1,3

¹Department of Cardiothoracic Surgery at Landspitali University Hospital, ²Department of Cardiology at Landspitali University Hospital, ³Faculty of Medicine at University of Iceland, ⁴Transplant Clinic at Landspitali University Hospital, ⁵Department of critical Care and Anesthesia at Landspitali University Hospital, ⁶Department of Cardiothoracic Surgery and Transplantation at Sahlgrenska University Hospital.

Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is

Key words: cardiac transplantation, heart transplant donation, heart failure, survival, cardiac surgery, Iceland.

 

INTRODUCTION: Information on the number, indications and outcome of cardiac transplantations in Icelandic patients is scarce, as is information on the number of hearts donated from Iceland for cardiac transplantation.

MATERIAL AND METHODS: A retrospective study on patients receiving heart transplantation from the first procedure in 1988 until March 2019. Clinical information was gathered from Landspitali Transplantation Clinic, patient charts, and information on donated hearts from the Icelandic Donation Registry. Age-standardized incidence of the procedure was calculated, and overall survival (Kaplan-Meier) estimated. Mean follow-up was 10.3 years.

RESULTS: Altogether 24 patients (19 males, median age 38 years, range: 4-65 years) underwent cardiac transplantation; that included one re-transplantation, three simultaneous heart- and lung transplants and two heart- and kidney transplants. The transplantations were performed in Gothenburg (n=20), London (n=3) and Copenhagen (n=2). Most common indications were dilated cardiomyopathy (n=10), congenital heart disease (n=4), and viral myocarditis (n=3). Five patients were bridged left ventricular-assist device preoperatively. Overall survival at 1 and 5 years was 91% and 86%, respectively; median survival being 24 years. The incidence of cardiac transplantation was 2.7 heart-TX pmp/year but increased to 4.6 heart-TX pmp/year after 2008 (p=0.01). During the same period 42 hearts were donated from Iceland for transplantation abroad, the first in 2002 and increasing from 0.8 to 3.0 hearts/year during the first and second half of the study-period, respectively.

CONCLUSION: Survival of Icelandic cardiac transplant recipients is good and comparable to larger transplant centers overseas. Number of hearts donated from Iceland have increased and currently Iceland donates twice as many hearts at it receives.

 

Figure 1. Incidence of heart transplantations in Iceland per million people/year from the first procedure in 1988 until March 2019.

 

Figure 2. Number of heart transplants per million people per year in Iceland and Scandiatransplant from 2009 till 2018.

Figure 3. Estimated overall survival (Kaplan-Meier) for Icelandic heart transplant recipients with 95% confidence interval.

Figure 4. Number of organ donations in Iceland per million people per year compared to the average number of organ donors in the Scandiatransplant database. Data is extracted from the Scandiatransplant Annual Data Report 2019.¹⁶

 

Table I. Indications for heart transplant in Icelandic patients from 1988 to 2019.

Table II. Number of hearts donated in Iceland for transplant overseas between 1992 and 2020.