Factors affecting long-term survival (>10 years) after cardiac transplantation in the cyclosporine era.
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.
John
R
R
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. ranjitj@pol.net
Rajasinghe
H A
HA
Itescu
S
S
Suratwala
S
S
Suratwalla
S
S
Lietz
K
K
Weinberg
A D
AD
Kocher
A
A
Mancini
D M
DM
Drusin
R E
RE
Oz
M C
MC
Smith
C R
CR
Rose
E A
EA
Edwards
N M
NM
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
D016572:Cyclosporine