title: Long-term outcomes after 1000 heart transplantations in six different eras of innovation in a single center.
abstract: The objective of this study was to evaluate long-term outcomes of cardiac transplantation (HTx) in different eras of innovation at a single center during a period of 27 years. We performed a retrospective analysis of 960 cardiac allograft recipients (40 re-HTx) between 1981 and 2008. The results of six different eras based on milestones in HTx were analysed: Era 1: the early years (n = 222,1981-1992); era 2: introduction of inhalative nitric oxide, prostanoids, University of Wisconsin solution (UW) replacing Bretschneider's solution (HTK,n = 118, 1992-1994); era 3: statins (n = 102, 1994-1995); era 4: tacrolimus(n = 115, 1995-1996); era 5: mycophenolate mofetil (MMF, n = 143, 1997-2000) and era 6: sirolimus (n = 300, 2000-2008). Outcome variables weresurvival, freedom from cardiac allograft vasculopathy (CAV) and from acute rejection episodes (AREs). Differences in survival was found comparing era 1 and era 2 with era 4 and era 6 (P < 0.001). Organ preservation through UW demonstrated a significantly better survival as compared with HTK(P < 0.001). Less AREs occurred in patients receiving tacrolimus-sirolimus ortacrolimus-MMF (P < 0.001). Patients receiving tacrolimus-MMF showed less CAV than when treated with cyclosporine-MMF (P < 0.005). There were more ventricular assist device implantations and more re-HTx in era 6 (P < 0.0001)than when compared with other eras. Although the causes for improvement in survival over time are multifactorial, we believe that changes in immunosuppressive therapy have had a major impact on survival.
authors.affiliation: Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany. sieglinde.kofler@med.uni-muenchen.de
authors.forename: Sieglinde
authors.initials: S
authors.lastname: Kofler
authors.forename: Amir K
authors.initials: AK
authors.lastname: Bigdeli
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Diana
authors.initials: D
authors.lastname: Kellerer
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Peter
authors.initials: P
authors.lastname: Uberfuhr
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D019188:Organ Preservation Solutions; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D019188:Organ Preservation Solutions; D009569:Nitric Oxide; D016559:Tacrolimus