Twenty-year survivors of heart transplantation at Stanford University.
Human heart transplantation started 40 years ago. Medical records of all cardiac transplants performed at Stanford were reviewed. A total of 1446 heart transplantations have been performed between January 1968 and December 2007 with an increase of 1-year survival from 43.1% to 90.2%. Sixty patients who were transplanted between 1968 and 1987 were identified who survived at least 20 years. Twenty-year survivors had a mean age at transplant of 29.4 +/- 13.6 years. Rejection-free and infection-free 1-year survivals were 14.3% and 18.8%, respectively. At their last follow-up, 86.7% of long-term survivors were treated for hypertension, 28.3% showed chronic renal dysfunction, 6.7% required hemodialysis, 10% were status postkidney transplantation, 13.3% were treated for diabetes mellitus, 36.7% had a history of malignancy and 43.3% had evidence of allograft vasculopathy. The half-life conditional on survival to 20 years was 28.1 years. Eleven patients received a second heart transplant after 11.9 +/- 8.0 years. The most common causes of death were allograft vasculopathy (56.3%) and nonlymphoid malignancy (25.0%). Twenty-year survival was achieved in 12.5% of patients transplanted before 1988. Although still associated with considerable morbidity, long-term survival is expected to occur at much higher rates in the future due to major advances in the field over the past decade.
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA. deuse@stanford.edu
T
T
Deuse
F
F
Haddad
M
M
Pham
S
S
Hunt
H
H
Valantine
M J
MJ
Bates
H R
HR
Mallidi
P E
PE
Oyer
R C
RC
Robbins
B A
BA
Reitz
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000601:surgery*; D006085:Graft Survival; D016027:Heart Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents; D008297:Male; D009017:Morbidity; D016019:Survival Analysis; D017741:Survivors; D014481:United States / Q000453:epidemiology
D007166:Immunosuppressive Agents