Ten year survival after heart transplantation: palliative procedure or successful long term treatment?

Abstract

Objective-To investigate the long term outcome and prognostic factors after heart transplantation. Setting-University hospital. Subjects-120 heart transplant patients (98 male, 22 female; underlying disease: dilated cardiomyopathy in 69, coronary artery disease in 42, miscellaneous in nine) who had undergone heart transplantation between October 1984 and October 1987. Immunosuppressive treatment was comparable in all patients and rejection episodes were treated in a uniform manner. Methods-Functional status, quality of life, and potential predictors for long term survival were investigated. Results-Actuarial survival rates were 65% at five years and 48% at 10 years; 58 patients survived > 10 years. The major causes of death were cardiac allograft vasculopathy (39%), acute rejection (18%), infection (11%), and malignancy (11%). Long term survivors had good exercise tolerance assessed by the New York Heart Association classification: 47 (81%) in grade I/II; 11 (19%) in grade III/IV. Echocardiography showed good left ventricular function in 48 patients. On angiography, severe allograft vasculopathy was present in only 16 patients (28%). Renal function was only slightly impaired, with mean (SD) serum creatinine of 148.5 (84.9) µmol/l. Multiple potential predictors of long term survival were analysed but none was found useful. Conclusions-Heart transplantation represents a valuable form of treatment. Survival for more than 10 years with a good exercise tolerance and acceptable side eVects from immunosuppression can be achieved in about 50% of patients. (Heart 1999;82:47-51)

Clinical and Exercise Test Determinants of Survival After Cardiac Transplantation *

“…5,6 In our proportional hazard analysis, we attempted to include factors previously shown to be markers of risk in CTX recipients, such as recipient CAD, donor and recipient age, and EF, 2,3,5,6 as well as hemodynamic and exercise test variables known to predict mortality in patients with CHF, eg, peak V o 2 , percentage of age-predicted peak V o 2 achieved, cardiac output, EF, and atrial natriuretic peptide. 9,12,20,21 Our findings are consistent with the observations of Fraund et al, 5 in which CTX patients who survived Ͼ 10 years were compared to those who survived Յ 10 years. There were no independent predictors of long-term survival by either univariate analysis or multivariate logistic regression, and no significant differences in donor or recipient characteristics between survivors and nonsurvivors.…”

“…Several clinical challenges persist in regard to treatment of CTX recipients that influence their long-term survival. These include accelerated coronary atherosclerosis and associated complications, [2][3][4][5] infection, 5,6 and stability of ventricular function. 3 …”

Heart Transplantation in Patients With End-Stage Heart Failure and Cardiac Ascites

“…1 Long-term survival is limited by transplant coronary artery disease and the complications produced by the toxicities of maintenance immunosuppression. [1][2][3] In recent decades, survival after heart transplantation is gradually improving, and there is increasing patient risk profiles before transplantation. 4 The increasing patient risk profiles include having had previous cardiac operations, use of mechanical assist devices, diabetes mellitus, critically ill recipients, high pulmonary vascular resistance, prior sensitization, long allograft ischemic time, and use of nonstandard or marginal donors.…”

Risk Stratification for Renal Transplantation after Cardiac or Lung Transplantation: Single-Center Experience and Review of the Literature

“…In long-term survivors after HTx (beyond the 5th year) the major causes of mortality were shown to be graft coronary artery disease and malignancy [3] . However, other authors [10,11] have failed to detect any independent prognostic variables for long-term survival after HTX.…”