title: Clinical outcome and quality of life of patients surviving 20 years or longer after heart transplantation.
abstract: To evaluate outcome and quality of life (QoL) in ≥ 20 years survivors after heart transplantation. Patients surviving ≥ 20 years with a single graft were retrospectively reviewed. Heterotopic, multiorgan and retransplantations were excluded. QoL was evaluated using the SF-36 survey. Eight hundred and twenty-seven heart transplants were performed from 1981 to 1993, and among these, 131 (16%) patients survived ≥ 20 years; 98 (75%) were male and mean age at transplant was 43 ± 13 years. Conditional survival in these 20 years survivors was 74.1 ± 4.3% at 23 years and 60.9 ± 5.3% at 25 years (45 deaths, 34%). Forty-four (34%) patients suffered rejection ≥ 2R. Conditional survival free from rejection ≥ 2R was 68 ± 4.1% at 5 years and 66.4 ± 4.2% at 10 years. Thirty-five (27%) patients had cardiac allograft vasculopathy (CAV) grade 2-3. Conditional CAV-free survival was 76 ± 3.8% at 20 years and 72.1 ± 4% at 25. Sixty-nine (53%) patients developed malignancy, mostly skin cancers. Conditional malignancy-free survival was 53.5 ± 4.4% at 20 years and 45.2 ± 4.6% at 25 years. At latest follow-up, 24.0 ± 3.0 years after transplantation, mean left ventricular ejection fraction was 62 ± 11% and mean physical and mental scores were 57 ± 23 and 58 ± 21, respectively. Sixteen per cent of heart recipients survived ≥ 20 years with good ventricular performance and QoL. CAV and malignancies account for late morbidity and mortality.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, La Pitiè-Salpêtrière Hospital, Paris, France.
authors.forename: Antonella
authors.initials: A
authors.lastname: Galeone
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Eleodoro
authors.initials: E
authors.lastname: Barreda
authors.forename: Flor
authors.initials: F
authors.lastname: Fernandez
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vaissier
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Shaida
authors.initials: S
authors.lastname: Varnous
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: cardiac allograft vasculopathy; heart transplantation; quality of life; survivors