title: Surviving 20 years after heart transplantation: a success story.
abstract: BACKGROUND
  We report the long-term outcomes of patients who survived 20 years or greater after heart transplantation.
  
  
  METHODS
  From 1985 to 2012, 386 patients underwent heart transplantation at our institution. Patient data were analyzed retrospectively for transplants performed from 1985 to 1991. The Kaplan-Meier method was used for survival analyses.
  
  
  RESULTS
  In total, 133 patients were included. The mean age of the 20-year survivors at transplant was 43.6±11.4 years. The mean ischemic time was 71.2±34.0 minutes. The overall actuarial survival rates at 1, 10, and 20 years were 82.7%, 63.9%, and 55.6%, respectively. The most common causes of death were graft rejection (21%), malignancy (21%), infection (15%), and cardiac allograft vasculopathy (CAV, 14%). After 1, 10, and 20 years, the rejection-free survival rates were 19%, 13%, and 13%, respectively, and the malignancy-free survival rates were 99%, 67%, and 61%. The CAV-free survival rates were 97%, 48%, and 42%, respectively, and the infection-free survival rates were, respectively, 70%, 15%, and 14%. The actuarial diabetes-free survival rates at 1, 10, and 20 years were 85%, 80%, and 79%, respectively. Actuarial hypertension-free survival was 56% after 1 year and 26% after 10 and 20 years. Two patients received a second heart transplant.
  
  
  CONCLUSIONS
  A remarkable number of patients survived 20 years or greater after heart transplantation, confirming the procedure as the gold standard for end-stage heart failure. Complications resulting from immunologic events and immunosuppressive therapy determine post-transplant mortality and morbidity. Due to improvements in immunosuppressive management in recent years, long-term survival is likely to increase.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez Cetina Biefer
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Simon H
authors.initials: SH
authors.lastname: Sündermann
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.affiliation: Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
authors.affiliation: Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Jacobs
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Mario L
authors.initials: ML
authors.lastname: Lachat
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. Electronic address: markus.wilhelm@usz.ch.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Wilhelm
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: 34