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.
Deuse
T
T
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA. deuse@stanford.edu
Haddad
F
F
Pham
M
M
Hunt
S
S
Valantine
H
H
Bates
M J
MJ
Mallidi
H R
HR
Oyer
P E
PE
Robbins
R C
RC
Reitz
B A
BA
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