Longer-term risks associated with 10-year survival after heart transplantation in the cyclosporine era.
BACKGROUND
Long-term survival after heart transplantation is common in the cyclosporine era. However, there are few data documenting pre-transplant/peri-operative factors predictive of truly long-term survival (>10 years). The purpose of this study is to identify factors associated with 10-year survival after heart transplantation.


METHODS
Our study population included 197 adults who survived >6 months and died <10 years after heart transplant (medium-term group) and 140 adults who survived >10 years after heart transplant (long-term group) between December 1980 and May 2001. A comparison was done between the two groups and we used multivariate analysis to identify which factors predicted 10-year survival.


RESULTS
The long-term group had younger recipient and donor age, lower recipient body mass index at transplant, shorter waiting time and lower percentages of ischemic etiology/male recipient/non-white recipient. Kaplan-Meier plots of freedom from graft coronary artery disease and malignancy showed later onset patterns in the long-term group compared with the medium-term group. Multivariate analysis showed that white recipient, younger recipient and lower recipient body mass index at heart transplant were factors significantly associated with 10-year survival.


CONCLUSIONS
Several pre-transplant/peri-operative factors were associated with survival beyond 10 years after heart transplantation. Stratified/tailored strategies based on these factors may be helpful to attain longer-term survival of recipients with higher risks.
Shiba
Nobuyuki
N
Division of Cardiovascular Medicine, Falk Cardiovascular Research Building, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94305, USA.
Chan
Michael C Y
MC
Valantine
Hannah A
HA
Gao
Shao-Zhou
SZ
Robbins
Robert C
RC
Hunt
Sharon A
SA
D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D016027:Heart Transplantation / Q000401:mortality*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine