Spanish heart transplant registry. 37th official report of the Heart Failure Association of the Spanish Society of Cardiology.

INTRODUCTION AND OBJECTIVES: The Spanish Heart Transplant Registry is updated annually with data on all heart transplants (HTs) performed in Spain. This report includes data through 2025. In particular, it analyzes the main characteristics of HTs performed over the past decade (2016-2025). METHODS: We performed a descriptive analysis of recipient and donor characteristics, surgical procedures, and follow-up events, as well as their temporal trends since 2016. Data were collected prospectively using a standardized electronic data collection form. RESULTS: In 2025, 390 HTs were performed, the highest annual number recorded in the registry, with 7% performed in pediatric recipients. Since 2016, significant trends have been observed toward lower rates of respiratory disease, previous cardiac surgery, mechanical ventilation, and serum bilirubin levels before HT, together with increased use of extracorporeal membrane oxygenation as pretransplant support. Donors were younger, and ischemic times were shorter. The use of controlled donation after circulatory death increased markedly, accounting for 35% of all HTs performed in 2025. Survival improved (85.5% at 1 year among patients transplanted in 2022-2024), and early mortality (within 30 days) declined to 7.5% in 2025 despite a significant increase in the incidence of severe primary graft dysfunction. CONCLUSIONS: HT activity has increased over the past 5 years, largely driven by the growing use of controlled donation after circulatory death. The improvements in early and mid-term survival are confirmed.