Five-year evaluation of the first heart transplant program in a European ultraperipheral region: characteristics, outcomes and implications

Abstract

Background In November 2019, the first heart transplant (HT) Program in a European ultraperipheral region was established following a Hub and Spoke model recommended by the European Society of Cardiology. This marked a significant milestone in transplant activity, that had to overcome numerous challenges given its geographical location and multi-insularity.

Objectives To analyze the characteristics, outcomes and implications of a novel five-year HT program in an outermost region.

Methods A retrospective analysis was conducted on patients who underwent HT between November 2019 and December 2024. Clinical, surgical, and follow-up data were retrieved retrospectively from the Heart Transplant Registry and a survival analysis was performed using Kaplan-Meier curve.

Results A total of 98 HT were performed using bicaval technique (one in December 2019, 15 in 2020, 17 in 2021, 22 in 2022, 21 in 2023, and 22 in 2024). Recipients had a mean age was of 55.3 ± 10.8, 19.4% female, and 44.9% had non-ischemic dilated cardiomyopathy. A low percentage of procedures were urgent (7%), and the intra-aortic balloon pump was the most used ventricular assist device (9.2%). The median time on waitlist CT was 58 days (IQR 6-86). Two and one donors were generated in Murcia and Madrid respectively, while 98% were local donors (figure 1A). Mean age of donors was 47.1 ± 12.9 years and 85.7% were male. Mean ischemia time was 151.7 ± 47.8 and, 20.4% were donors from controlled donation after circulatory death. The one-year and two-year survival rate were 93.6% and 87.9% respectively (figure 1B).

Conclusions The first and only HT program in a European ultraperipheral region has overcome the geographical and logistical challenges it presented, demonstrating self-sufficiency, excellent coordination and favorable survival outcomes. This HT program could serve as an example for other regions with similar characteristics to ours. However, we should await long-term outcomes, and its broader applicabilily should be evaluated.