Outcomes and complications after heart transplantation: a review.
In more than 35 years of experience with heart transplantation, improvements in patient selection, surgical techniques, organ preservation, and postoperative management have increased survival rates and reduced complications. However, a number of significant complications continue, limiting the benefit of heart transplantation as the long-term solution for patients. Current survival rates are 83% at 1 year and 72% at 5 years, with 50% of patients surviving 9.4 years or more. Recipient and donor characteristics influence survival outcome. Primary graft dysfunction is the most frequent cause of death during the first 30 days. The function of the transplanted heart allows return to pre-illness activities, though denervation limits peak exercise capacity. Advances in immunosuppressive medications have decreased the incidence and severity of rejection, though only recently have shown promise in attenuating the incidence of cardiac graft vasculopathy, the major complication limiting long-term graft function. This review addresses current outcomes and the short- and long-term complications of heart transplantation.
Hoffman
Frances M
FM
Transplant Services, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN 55407, USA. frances.hoffman@allina.com
D001706:Biopsy; D002423:Cause of Death; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality* / Q000639:trends; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced; D006973:Hypertension / Q000139:chemically induced; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000401:mortality* / Q000639:trends; D007239:Infections / Q000139:chemically induced; D007674:Kidney Diseases / Q000139:chemically induced; D009369:Neoplasms / Q000139:chemically induced; D010024:Osteoporosis / Q000139:chemically induced; D018579:Patient Selection; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D014181:Transplantation Immunology; D016896:Treatment Outcome