title: When and why do heart transplant recipients die? A 7 year experience of 1068 cardiac transplants.
abstract: This mortality study deals with the 1068 heart transplants (1054 patients) performed in Italian Units from November 1985 to April 1992. The death rate was 19.7% and the actuarial survival was 89% at 1 month, 83% at 1 year and 74% at 6.5 years. Recipients who died had been less often transplanted for dilated cardiomyopathy, were older (44.1 vs. 41.7 years) and more often male (84.5 vs. 72.7%). Analysis of the causes of death was restricted to orthotopic transplantations (1029/1068 procedures, 195/208 deaths). Deaths were grouped within four intervals: peri-operative (< or = 1 month, 50.0% of deaths), early (> 1 month < or = 3 months, 17.2%), intermediate (> 3 months < or = 2 years, 22.6%) and late (> 2 years, 10.2%). The prime causes of death were mostly postoperative graft failure (whose effects brought about 64% of peri-operative deaths, 28% of early and 7% of intermediate deaths), post-operative complications (10% of peri-operative deaths), acute rejection (10% of total deaths, distributed in all the periods), graft arteriopathy (6% of early, 36% of intermediate and 58% of late deaths), infections (17% of deaths, occurring in all periods but late) and malignant tumours (7% of deaths), lymphomas being the first to occur and Kaposi's sarcoma occurring only in the intermediate period. Repeat transplantation had a poor outcome (death rate 71.4%), two-thirds of the re-transplanted patients' deaths being due to early graft failure and a third to late relapsing graft vasculopathy.
authors.affiliation: Section of Cardiovascular Pathology, La Sapienza University Hospital, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gallo
authors.forename: G
authors.initials: G
authors.lastname: Baroldi
authors.forename: G
authors.initials: G
authors.lastname: Thiene
authors.forename: L
authors.initials: L
authors.lastname: Agozzino
authors.forename: E
authors.initials: E
authors.lastname: Arbustini
authors.forename: G
authors.initials: G
authors.lastname: Bartoloni
authors.forename: E
authors.initials: E
authors.lastname: Bonacina
authors.forename: C
authors.initials: C
authors.lastname: Bosman
authors.forename: G
authors.initials: G
authors.lastname: Catani
authors.forename: P
authors.initials: P
authors.lastname: Cocco
mesh_terms: D000328:Adult; D005260:Female; D006083:Graft Occlusion, Vascular / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged