Introduction: According to Brazilian public policies, as observed in several other countries, and with some scientific publications regarding supporting this idea, a multidisciplinary approach is one of the pillars for achieving significantly relevant outcomes, particularly in heart transplantation (HTx). Supported by this vision, the Thoracic Organ Transplant Center was established at the largest Brazilian university hospital.
Objectives: The aim of this study was to monitor and evaluate the impact of this Heart Transplant Center, especially in two distinct eras: before and after the creation of this multidisciplinary model.
Material and Methods: A retrospective transversal study was conducted from 2002 to 2023, analyzing 1264 recipients registered on the waiting list for HTx. Data were collected from the Central Transplant Registry of the São Paulo State Health Department. The data were divided into two eras: from 2002 to 2012 (pre-center period - PCP) and from 2013 to 2023 (center period - CP), and described in absolute and relative frequencies. The Chi-square test was applied to compare the eras, with values of p < 0.05 considered significant.
Results: In the pre-center period, 469 recipients were registered, of which 343 (73.1%) met priority criteria. Inotropes support (IS) was the most prevalent prioritization with 227 (66.2%) patients. During this period, 222 HTx were performed, with 161 (72,5%) recipients in priority with IS, with highest number of HTx (50%). In the same period, 53,1% of the prioritized recipients died pre-HTx and 27,5% of the HTx were performed in non-prioritized recipients. Comparatively, in the CP, 795 recipients were registered, an increase of 70%, compared to the PCP. Of these registrations, 90.1% of recipients were prioritized - a 108.7% increase compared to PCP). During the CP, intra-aortic balloon pump (IABP) was the most prevalent prioritization, with 385 recipients (53.8%), reflecting a 288.9% increase in cases prioritized by IABP (p < 0.001). When analyzing recipients prioritized by IS, we noticed stability in the number of recipients in both periods: pre-center (n= 227) vs center (n= 223). However, we observed a decrease of 51.25% in HTx prioritized by IS, compared to the 521 HTx in the CP (66.2% to 31.1%). It is noteworthy that, in the CP, HTx increased significantly by 135%, reaching 521 HTx, when 275 (52.8%) were prioritized with IABP support. We also observed a reduction of 15.83% in pre-HTx deaths, but in theCP, only 26 recipients received HTx as non-prioritized (4.99% of cases).
Conclusion: The high number of recipients meeting priority criteria, as well as changes observed in the recipients' profiles (IS vs IABP) in both eras, inferring greater severity of recipients, explaining high mortality rate on the waiting list, leading us to discuss new alternatives, such as the formation of Centers like this, aiming improve grafts allocation processes, regarding the best utilization of available hearts.