title: Outcome of heart transplants 15 to 20 years ago: graft survival, post-transplant morbidity, and risk factors for mortality.
abstract: OBJECTIVE
  The study was conducted to determine the long-term outcome of patients who underwent heart transplantation 15 to 20 years ago, in the cyclosporine era, and identify risk factors for death.
  
  
  METHODS
  A retrospective analysis was done of 148 patients who had undergone heart transplantation between 1985 and 1991 at a single center. Operative technique and immunosuppressive treatment were comparable in all patients.
  
  
  RESULTS
  Actuarial survival rates were 75% (n = 111), 58% (n = 86), and 42% (n = 62) at 5, 10, and 15 years, respectively. The mean follow-up period was 12.1 +/- 5.6 years for patients who survived more than 3 months after transplantation (n = 131). The major causes of death were malignancy (35.8%) and cardiac allograft vasculopathy (24.7%). No death related to acute rejection was reported after the first month of transplantation. Graft coronary artery disease was detected on angiography in 66 (50.3%), and 7 (5.3%) had retransplantation. Malignancies developed in 131 patients (48.1%), including skin cancers in 31 (23.6%), solid tumors in 26 (19.8%), and hematologic malignancies in 14 (10.6%). Severe renal function requiring dialysis or renal transplantation developed in 27 patients (20.6%). By multivariable analysis, the only pre-transplant risk factor found to affect long-term survival was a history of cigarette use (p < 0.0004).
  
  
  CONCLUSIONS
  Long-term survival at 15 years after cardiac transplantation remains excellent in the cyclosporine era. Controlling acute allograft rejection can be achieved but seems to carry a high rate of cancers and renal dysfunction. History of cigarette use affects significantly long-term survival in our study.
authors.affiliation: Department of Cardiothoracic Surgery, Nantes Hospital University, Nantes, France. eanchristian.roussel@chu-nantes.fr
authors.forename: Jean C
authors.initials: JC
authors.lastname: Roussel
authors.forename: Olivier
authors.initials: O
authors.lastname: Baron
authors.forename: Christian
authors.initials: C
authors.lastname: Périgaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Bizouarn
authors.forename: Sabine
authors.initials: S
authors.lastname: Pattier
authors.forename: Oussama
authors.initials: O
authors.lastname: Habash
authors.forename: Antoine
authors.initials: A
authors.lastname: Mugniot
authors.forename: Thierry
authors.initials: T
authors.lastname: Petit
authors.forename: Jean L
authors.initials: JL
authors.lastname: Michaud
authors.forename: Marie Françoise
authors.initials: MF
authors.lastname: Heymann
authors.forename: Michèle
authors.initials: M
authors.lastname: Treilhaud
authors.forename: Jean N
authors.initials: JN
authors.lastname: Trochu
authors.forename: Jean P
authors.initials: JP
authors.lastname: Gueffet
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lamirault
authors.forename: Daniel
authors.initials: D
authors.lastname: Duveau
authors.forename: Philippe
authors.initials: P
authors.lastname: Despins
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D006085:Graft Survival / Q000187:drug effects*; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine