Cardiac transplantation at the University of Pittsburgh: 1980 to 1991.
When examining survival rates following cardiac transplantation, it is important to examine the risk factors for both early (30-day) and late (greater than 30-day) survival as they may well be different. Factors affecting early survival appear related more to the preoperative condition of the patient (including degree of pulmonary hypertension) as well as advances that have been made in postoperative care. It is not immediately obvious why gender has such a profound effect on early survival and why primary graft failure rates appear higher in this group. Donor organ factors did not appear to relate to this difference. On the other hand, late survival appears to be influenced mainly by immunologic factors such as panel reactive antibody level and immunosuppressive protocol. A less dramatic effect of transpulmonary gradient appears to have a lasting effect on recipients even when they survive the initial 30-day period. Thus, pulmonary hypertension may have prolonged effects on the cardiac allograft which as yet we do not understand completely. The majority of late mortality is still due to graft atherosclerosis, infection, and acute cellular rejection, the latter 2 occurring most frequently within the first year after transplantation whereas death from graft atherosclerosis becomes most prominent beyond 5 years. Despite persistent improvements in 30-day survival, late survival following cardiac transplantation will only improve with the advent of better tissue matching and improved immunosuppression. The results with FK506, for example, are promising.
Kormos
R L
RL
Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Armitage
J M
JM
Hardesty
R L
RL
Hattler
B G
BG
del Nido
P
P
Marrone
G C
GC
Lee
A
A
Uretsky
B F
BF
Murali
S
S
Griffith
B P
BP
D000328:Adult; D002423:Cause of Death; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality; D007165:Immunosuppression Therapy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016042:Transplantation, Heterotopic / Q000706:statistics & numerical data
D016572:Cyclosporine