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Updated: Jul 16, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Thirty years of cardiac transplantation at Stanford university
R C Robbins1, C W Barlow, P E Oyer
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, CA, USA.
Insights
Improved immunosuppression, including cyclosporine and OKT3, significantly enhanced cardiac transplant survival over three decades. This led to reduced death rates from rejection, infection, and graft coronary artery disease, improving patient outcomes.
Area of Science:
- Cardiology
- Immunology
- Transplantation Science
Background:
- Review of 30 years of cardiac transplantation experience at Stanford University Medical Center.
- Analysis of 954 transplants in 885 patients, categorized by immunosuppression regimens.
- Group I: no cyclosporine (1968-1980), Group II: cyclosporine (1980-1987), Group III: cyclosporine + OKT3 (1987-1998).
Purpose of the Study:
- To evaluate the impact of evolving immunosuppression strategies on cardiac transplant outcomes.
- To analyze survival rates and causes of death over three decades.
- To identify trends in rejection, infection, and graft coronary artery disease.
Main Methods:
- Retrospective review of cardiac transplant patient data.
- Categorization of patients into three groups based on immunosuppression therapy.
- Actuarial analysis of survival and death rates at 1, 5, and 10 years post-transplant.
Main Results:
- Actuarial survival rates significantly improved across groups: 24% (Group I) to 46% (Group III) at 10 years.
- Death rates from rejection decreased from 14% (Group I) to 5% (Group III) at 10 years.
- Death rates from infection and graft coronary artery disease also showed significant reductions with advanced immunosuppression.
Conclusions:
- Cardiac transplant outcomes have markedly improved over 30 years due to advancements in immunosuppression.
- Reduced rejection, infection, and graft coronary artery disease contribute to better survival.
- Further improvements in perioperative care and immunosuppressive agents are expected to enhance long-term survival and quality of life.
Background:
The experience with 30 years of cardiac transplantation at Stanford University Medical Center was reviewed. A total of 954 transplants were performed in 885 patients. Patients were divided into 3 groups based on immunosuppression received: group I, no cyclosporine (INN: ciclosporin) (n = 201) (January 1968-November 1980); group II, cyclosporine (n = 248) (December 1980-June 1987); and group III, cyclosporine + OKT3 (n = 436) (July 1987-March 1998).
Results:
The 1-, 5-, and 10-year actuarial survivals were 68%, 41%, and 24% (group I); 80%, 57%, and 37% (group II); and 85%, 68%, and 46% (group III) (I vs II, P <.01; I vs III, P <.005; and II vs III, P <.005). The 1-, 5-, and 10-year actuarial death rates from rejection were 8%, 12%, and 14% (group I); 5%, 7%, and 7% (group II); and 2%, 5%, and 5% (group III) (I vs II, P = not significant; I vs III, P <.005; and II vs III, P <.005). The 1-, 5-, and 10-year actuarial death rates from infection were 25%, 43%, and 50% (group I); 8%, 17%, and 29% (group II); and 6%, 11%, and 16% (group III) (I vs II, P <.005; I vs III, P <.005; and II vs III, P <.05). The 1-, 5-, and 10-year actuarial death rates from graft coronary artery disease were 0%, 5%, and 13% (group I); 0%, 12%, and 19% (group II); and 1%, 6%, and 9% (group III) (I vs II, P <.01; I vs III, P <.005; and II vs III, P = not significant). There have been 69 retransplants in 67 patients with 1-, 5-, and 10-year actuarial survivals of 49%, 27%, and 15%, respectively.
Conclusions:
The evolution of 3 decades of experience with cardiac transplantation has resulted in improved overall survival. The incidence of rejection and of death from infection and graft coronary artery disease have decreased over time, primarily as a result of improvements in immunosuppression and in the prevention and treatment of infection. Continued advances in perioperative management and the development of more specific, less toxic immunosuppressive agents could further refine this initial experience and improve the survival and quality of life of patients after cardiac transplantation.
