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Introduccion y objetivos Los receptores de trasplante cardiaco que sobreviven mas de 20 anos estan aumentando. Poco se conoce de su seguimiento, sus comorbilidades y su mortalidad. Identificar predictores de larga supervivencia puede guiar la seleccion de candidatos para los donantes disponibles. Metodos Se reviso la informacion sobre la clase funcional, las comorbilidades y la mortalidad de pacientes trasplantados antes de 1992. Para identificar los predictores de supervivencia > 20 anos, se construyo un modelo de regresion logistica utilizando las variables asociadas a supervivencia en el analisis univariable. Resultados Se comparo a 39 supervivientes con seguimiento > 20 anos (el 26% del total) con 90 pacientes que sobrevivieron entre 1 y 20 anos. Las principales complicaciones fueron hipertension, disfuncion renal, infecciones y neoplasias. Tras 30 meses de seguimiento, 6 murieron, lo que implica una mortalidad del 6%/ano (frente a un 2,5-3% en los anos 1 a 19). Las principales causas de muerte fueron infeccion (50%), cancer (33%) y vasculopatia del injerto (17%). Los supervivientes eran mas jovenes y delgados, y tenian cardiopatia no isquemica y menos isquemia en cirugia. La regresion logistica identifico la edad del receptor 20 anos. Conclusiones En nuestra serie, mas del 25% sobrevive mas de 20 anos con el mismo injerto y lleva vida independiente a pesar de las comorbilidades. La edad del receptor < 45 anos y la miocardiopatia idiopatica se asociaron a larga supervivencia. Estos datos pueden ayudar a la asignacion de donantes.

The number of heart-transplant recipients exceeding 20 years of follow-up is steadily increasing. However, little is known about their functional status, comorbidities, and mortality. Identifying the predictors of prolonged survival could guide the selection of candidates for the low number of available donors.Functional status, morbidities, and mortality of heart-transplant patients between 1984 and 1992 were analyzed. To identify predictors of 20-year survival, a logistic regression model was constructed using the covariates associated with survival in the univariate analysis.A total of 39 patients who survived 20 years (26% of patients transplanted before 1992) were compared to 90 recipients from the same period who died between 1 and 20 years post-transplantation. Major complications were hypertension, renal dysfunction, infections, and cancer. After a mean follow-up of 30 months, 6 survivors had died, yielding a mortality rate of 6% per year (vs 2.5%-3% in years 1-19). Causes of mortality were infection (50%), malignancy (33%), and allograft vasculopathy (17%). Long-term survivors were younger and leaner, and had nonischemic cardiomyopathy and lower ischemic time. Logistic regression identified recipient age45 years (odds ratio=3.9; 95% confidence interval, 1.6-9.7; P=.002) and idiopathic cardiomyopathy (odds ratio=3; 95% confidence interval, 1.4-7.8; P=.012) as independent predictors for 20-year survival.One fourth of all heart-transplant patients in our series survived20 years with the same graft, and most enjoy independent lives despite significant comorbidities. Recipient age45 years and idiopathic cardiomyopathy were associated with survival beyond 2 decades. These data may help decide donor allocation.