title: Factors affecting long-term survival (>10 years) after cardiac transplantation in the cyclosporine era.
abstract: OBJECTIVE
  The aim of this study was to determine long-term survival (>10 years) after cardiac transplantation in the cyclosporine era and identify risk factors influencing long-term survival.
  
  
  BACKGROUND
  Despite the availability of newer modalities for heart failure, cardiac transplantation remains the treatment of choice for end-stage heart disease.
  
  
  METHODS
  Between 1983 and 1988, 195 patients underwent heart transplantation at a single center for the treatment of end-stage heart disease. Multivariable logistic regression analysis of pretransplant risk factors affecting long-term survival after cardiac transplantation included various recipient and donor demographic, immunologic and peritransplant variables.
  
  
  RESULTS
  Among the group of 195 cardiac transplant recipients, actuarial survival was 72%, 58% and 39% at 1, 5 and 10 years respectively. In the 65 patients who survived >10 years, mean cardiac index was 2.91/m2 and mean ejection fraction was 58%. Transplant-related coronary artery disease (TRCAD) was detected in only 14 of the 65 patients (22%). By multivariable analysis, the only risk factor found to adversely affect long-term survival was a pretransplant diagnosis of ischemic cardiomyopathy (p = 0.04).
  
  
  CONCLUSIONS
  Long-term survivors maintain normal hemodynamic function of their allografts with a low prevalence of TRCAD. It is possible that similar risk factors that lead to coronary artery disease in native vessels continue to operate in the post-transplant period, thereby contributing to adverse outcomes after cardiac transplantation. Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of coronary atherosclerosis and enable long-term survival after cardiac transplantation.
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. ranjitj@pol.net
authors.forename: R
authors.initials: R
authors.lastname: John
authors.forename: H A
authors.initials: HA
authors.lastname: Rajasinghe
authors.forename: S
authors.initials: S
authors.lastname: Itescu
authors.forename: S
authors.initials: S
authors.lastname: Suratwala
authors.forename: S
authors.initials: S
authors.lastname: Suratwalla
authors.forename: K
authors.initials: K
authors.lastname: Lietz
authors.forename: A D
authors.initials: AD
authors.lastname: Weinberg
authors.forename: A
authors.initials: A
authors.lastname: Kocher
authors.forename: D M
authors.initials: DM
authors.lastname: Mancini
authors.forename: R E
authors.initials: RE
authors.lastname: Drusin
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
authors.forename: E A
authors.initials: EA
authors.lastname: Rose
authors.forename: N M
authors.initials: NM
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D003327:Coronary Disease / Q000401:mortality; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality* / Q000517:prevention & control; D016027:Heart Transplantation / Q000401:mortality*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D016572:Cyclosporine