title: Heart transplantation: 25 years' single-centre experience.
abstract: OBJECTIVE
  Heart transplantation (HTx) is still one of the most effective therapies for end-stage heart disease for patients with no other medical or surgical therapy. We report the results of our 25-year orthotropic HTx single-centre experience.
  
  
  METHODS
  From November 1985, 905 orthotopic heart transplants have been performed at our centre. We exclude from the present analysis 13 patients who underwent re-transplantation and 14 pediatric cases (age at HTx <15 years).
  
  
  RESULTS
  The present study collected the data of 878 primary adult orthotopic HTx performed at our centre. Mean age at HTx was of 49.6 ± 11.6 years. Mean donor age was 36.9 ± 14.8 years. Hospital mortality was 11.6% (102 patients), early graft failure was the principal cause of death (58 patients) followed by infections (18 cases) and acute rejection (7 patients). Overall actuarial survival was 78.1% at 5 years and 63.8% and 47.5%, respectively, at 10 and 15 years from HTx. Mean survival was 10.74 years; 257 late deaths were reported (33.1%); main causes were neoplasm in 83 patients, and cardiac causes included coronary allograft vasculopathy in 78 patients. Freedom from any infection at 5, 10 and 15 years was 52.2, 44.1 and 40.1%, respectively. Freedom from rejection at 5 years was 36.2%, with 493 patients experiencing at last one episode of rejection, the majority occurring during the first 2 months after transplantation. The long-term survival of HTx recipients is limited in large part by the development of coronary artery vasculopathy and malignancies. In our experience freedom from coronary allograft vasculopathy at 10 years was 66.9%, and 85 patients underwent percutaneous coronary revascularization. In our study population, 44 patients experienced posttransplant lymphoproliferative disorder and 91 patients experienced a solid neoplasm, mean survival free from neoplasm was 12.23 years.
  
  
  CONCLUSIONS
  Over the past four decades the field of HTx has evolved considerably, with improvements in surgical techniques and postoperative patients' care. A careful patient selection and treatment of candidates for transplantation as well as accurate clinical follow-up combined with real multidisciplinary teamwork that involved different heart failure specialists, allowed us to obtain our excellent long-term results.
authors: Cardiology and Cardiac Surgery Department bCardiothoracic Anesthesia and Intensive-care, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
authors: Giuseppe
authors: G
authors: Bruschi
authors: Tiziano
authors: T
authors: Colombo
authors: Fabrizio
authors: F
authors: Oliva
authors: Luca
authors: L
authors: Botta
authors: Nuccia
authors: N
authors: Morici
authors: Aldo
authors: A
authors: Cannata
authors: Claudia
authors: C
authors: Vittori
authors: Fabio
authors: F
authors: Turazza
authors: Andrea
authors: A
authors: Garascia
authors: Giovanna
authors: G
authors: Pedrazzini
authors: Maria
authors: M
authors: Frigerio
authors: Luigi
authors: L
authors: Martinelli
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D059347:Cardio-Renal Syndrome / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D003324:Coronary Artery Disease / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008232:Lymphoproliferative Disorders / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D061646:Operative Time; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D017678:Sex Distribution; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents