Late complications of heart transplantation: an 11-year experience.
Advances in donor and recipient selection and postoperative management of patients undergoing a heart transplant have improved survival after cardiac transplantation; nevertheless, late complications are still the main cause of mortality. Between January 1988 and March 1999, 200 heart transplants and 2 retransplants were performed at our Institution. The actuarial survival rate was 84.45% at 1 month, 75.22% at 1 year, and 69.48% at 5 years. One-hundred forty-five patients reached at least 6 months of follow-up. In this group of patients we reviewed all available pathological specimens from endomyocardial biopsies, autopsies, and hearts retrieved at retransplantation. The most frequent late complications have been: malignancies (9 patients), allograft coronary artery disease (ACAD) (6 patients), and infections (6 patients). All patients with ACAD had serological evidence of cytomegalovirus (CMV) infection and 5 of them (83.3%) of hepatitis C virus (HCV) infection. Squamous cell lung carcinoma and Kaposi's sarcoma were the most frequent neoplasms (3 patients). Twenty-six out of 145 patients died during the follow-up: sudden death occurred in 10 patients (38.46%), infections caused death in 6 patients (23.08%). ACAD in 4, and cancer in 4. Causes and rates of late mortality in patients with a cardiac transplant differ from those of early mortality. Development of infections, ACAD, or cancer is associated with a high late mortality rate. A striking correlation has been found between ACAD and HCV and/or CMV positivity. suggesting that such viruses may play a role in the development of vascular late complications in transplanted hearts.
Esposito
S
S
Institute of Pathology, Second University of Naples, Italy.
Renzulli
A
A
Agozzino
L
L
Thomopoulos
K
K
Piccolo
M
M
Maiello
C
C
Della Corte
A
A
Cotrufo
M
M
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002423:Cause of Death; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D017211:Treatment Failure