Browsing by Author "Strandell, Kesia"

Filter results by typing the first few letters
Now showing 1 - 1 of 1
  • No Thumbnail Available
    Item
    Characteristics and prognosis for patients discussed at the multi-disciplinary heart transplantation board at Sahlgrenska University Hospital
    (2022-05-23) Strandell, Kesia; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
    The first heart transplant was performed in 1967 in South Africa, and since then approximately 118,000 heart transplants have been performed worldwide. Today, approximately 4000 heart transplants are performed annually, of which 60-70 are performed in Sweden. Heart transplantation (HTx) may be offered to patients with severe heart failure and in a few cases HTx is indicated as a final stage treatment for patients with arrhythmias as well as inoperable valve abnormalities. Approximately 60 - 70 patients are admitted to the multidisciplinary transplant board for HTx annually at Sahlgrenska University hospital and about 35 of these are accepted for heart transplantation. The underlying reasons why patients are not considered suitable for transplantation are comorbidity, noncompliance and malignancy. All patients referred for a transplant evaluation undergoes a comprehensive examination, both physical as well as psychiatric to rule out potential treatable causes of the end-stage heart syndrome, potential absolute exclusion criteria and sort out patients that may be eligible for an orthotropic heart transplantation. The main objective for this thesis, using data that was collected retrospectively from 2008 to 2018, to characterize patients discussed at the multidisciplinary transplantation board at Sahlgrenska University Hospital as well as survival. The patients were categorized into three different groups depending on the board decision, suitable to undergo HTx (cohort 1) or unsuitable for HTx, containing patients assessed as not sick enough (cohort 2) or too sick (cohort 3). The three different groups were analysed in relation to their background variables as well as overall survival. The overall survival rate for those patients that were not accepted in cohort 3 was bad, 60% 2-years and 40% 10-years survival rate, in comparison to cohort 2, where the 2- and 10-years survival rate was 90% respectively 80%. Concluding that those patients not accepted for a heart transplant who were judged not sick enough (cohort 2) had as good prognosis as those receiving a HTx (cohort 1). The study found that there were almost no differences in the background variables that the multidisciplinary board base their decision on between the three different groups, with some exceptions. Cohort 2 are considerably younger and cohort 3 has a significantly older age group. Co-morbidity increases with age and could be one explanatory reason. The most common diagnosis amongst patients denied HTx due to being too sick (cohort 3) is ischemic heart disease (IHD) at the same time as an increased mortality rate were detected for patient diagnosed with IHD that do receive a heart transplant (cohort 1). Furthermore, the study reveals elevated mean pulmonary artery pressure (MPAP) as one predictor that correlates with higher mortality risk for patients denied a heart transplant (cohort 3). In alignment with previous findings, patients that were not accepted for heart transplant because they were judged not sick enough (cohort 2) had a better functional level in cardiopulmonary exercise tests, regarding peak O2 and max watt.