Orthotopic Heart Transplantations in a Newly Opened Transplantation Center in Poland: Population Description and Prognosis

Introduction: Heart transplantation (HTx) remains the definitive treatment for selected patients with advanced heart failure. The early post-transplant period is characterized by substantial morbidity and requires intensive surveillance. The aim of this study was to describe the clinical course of the first 100 heart transplant recipients treated at our newly established center, with particular emphasis on in-hospital outcomes and the 12-month follow-up. Methods: We retrospectively analyzed 100 consecutive patients who underwent orthotopic HTx between February 2021 and May 2023 at our center. Demographic, clinical, hemodynamic, laboratory, treatment, and post-transplant follow-up data were collected. The follow-up assessment included survival, rejection, infectious complications, renal replacement therapy (RRT), heart failure decompensation, hospitalizations, outpatient visits, and changes in pharmacotherapy. Cox proportional hazards regression and Receiver Operating Characteristic (ROC) analyses were also performed to assess factors associated with 12-month mortality. Results: The study population comprised 82 (82%) men and 18 (18%) women with a median age of 54 years (IQR, 45–64). The in-hospital course was characterized by substantial early morbidity: 17 patients (17%) died during the index hospitalization, with a median time to death of 17 days (IQR, 3–78). RRT was required in 44% of patients. Among hospital survivors, the median length of hospital stay was 43 days and the median ICU stay was 7 days. During the 12-month follow-up, clinically significant cellular graft rejection (grade ≥ 3) occurred at least once in 51% of patients, infectious complications in 45%, and one patient underwent retransplantation. The twelve-month all-cause mortality was 23%. Patients had a mean of 8 planned hospitalizations, 0.4 unplanned admissions, and 1.3 outpatient visits per patient. Exploratory analyses identified possible associations between selected pre-transplant variables and 12-month mortality. Conclusions: The first 100 HTx recipients treated at the newly established center experienced a clinically demanding in-hospital course, with a 17% in-hospital mortality. After discharge, the first year remained characterized by frequent cellular rejection incidence, and infectious complications. The twelve-month survival was 77%. These findings provide a comprehensive description of the early in-hospital and 12-month clinical course of a newly established Htx program.