Recent trends in early outcome of adult patients after heart transplantation: a single-institution review of 251 transplants using standard donor organs.
Older age, prior transplantation, pulmonary hypertension, and mechanical support are commonly seen in current potential cardiac transplant recipients. Transplants in 436 consecutive adult patients from 1994 to 1999 were reviewed. There were 251 using standard donors in 243 patients (age range 18-69 years). To emphasize recipient risk, 185 patients who received a nonstandard donor were excluded from analysis. The indications for transplant were ischemic heart disease (n = 123, 47%), dilated cardiomyopathy (n = 82, 32%), and others (n=56, 21%). One hundred and forty-nine (57%) recipients were listed as status I; 5 and 6% were supported with an intra-aortic balloon and an assist device, respectively. The 30-d survival and survival to discharge were 94.7 and 92.7%, respectively; 1-year survival was 89.1%. Causes of early death were graft failure (n = 6), infection (n = 4), stroke (n = 4), multiorgan failure (n = 3) and rejection (n = 2). Predictors were balloon pump use alone (OR= 11.4, p =0.002), pulmonary vascular resistance > 4 Wood units (OR = 5.7, p = 0.007), pretransplant creatinine > 2.0 mg/dL (OR = 6.9, p = 0.004) and female donor (OR = 8.3, p = 0.002). Recipient age and previous surgery did not affect short-term survival. Heart transplantation in the current era consistently offers excellent early and 1-year survival for well-selected recipients receiving standard donors. Early mortality tends to reflect graft failure while hospital mortality may be more indicative of recipient selection.
Heart Transplant Program, University of California, Los Angeles, Center for Health Sciences, 90095-1741, USA.
Feng-Chun
FC
Tsai
Daniel
D
Marelli
Jessica
J
Bresson
David
D
Gjertson
Reza
R
Kermani
Abbas
A
Ardehali
Fardad
F
Esmailian
Michele
M
Hamilton
Gregg C
GC
Fonarow
Jaime
J
Moriguchi
Mark
M
Plunkett
Antoine
A
Hage
Julie
J
Tran
Jon A
JA
Kobashigawa
Hillel
H
Laks
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome