Spanish Heart Transplantation Registry. 21st Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984–2009)

Heart transplantation: organisational aspects and current trends in immunosuppression—a view from Spain

“…w2 Data derived from the voluntary Registry of the International Society for Heart and Lung Transplantation (ISHLT) show that median survival after HTx is 10 years, and >90% of recipients live without significant activity limitations 2 . w1 Similar results are shown in the exhaustive Spanish National Registry of Heart Transplantation (RNTC) 4. In our own series of 770 HTx starting in 1984, 25% of the patients transplanted ≥20 years ago are still alive, most of them leading satisfactory, independent lifestyles.…”

“…On the one hand, advances in the field of immunology leading to the development of drugs (ie, ciclosporin A) have allowed safe immunomodulation strategies. Acute rejection is not a major barrier to graft survival any more, and newer generation, more specific immunosuppressive drugs have an acceptably low profile of adverse effects 4 . w3–w5 On the other hand, refinements in the selection of recipients, improvement in surgical techniques, a better preservation of the graft during cold ischaemia, histological monitoring of acute rejection, and implementation of prophylactic strategies against specific infections have undoubtedly contributed to the success of HTx 5 6…”

“…This balance is a moving target, because the risks of these complications change differentially over time after HTx—that is, acute rejection is more frequent during the first 6 months, while malignancies are the first cause of mortality among long term (>5 years) survivors 2 4…”

“…2 4 w1 During the first month after HTx, primary graft failure and complications related to surgical trauma are the leading causes. From the first month to the end of the first year, the period of maximal immunosuppression, infectious episodes account for 30% of deaths, while acute rejection causes 10% of the mortality.…”

Plasmablastic Posttransplant Lymphoma

“…Heart transplants usually account for only 10% to 30% of PTLD (26 -28) and DCM in turn accounts for only approximately 30% of heart transplants (29). One potential explanation is that the combination of prolonged survival of these young patients with few cardiovascular risk factors and the long interval from transplantation to diagnosis of PBL-PTLD (more than 10 years in 7/8 cases in this series) leads to selection bias.…”