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Ten year survival after heart transplantation: palliative procedure or successful long term treatment?
1Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, 30623 Hannover, Germany.
Insights
Heart transplantation offers long-term survival for about half of patients, with good exercise capacity and manageable side effects. This study investigated outcomes and prognostic factors in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunosuppression
Background:
- Heart transplantation is a critical treatment for end-stage heart failure.
- Understanding long-term outcomes and survival predictors is essential for patient management.
Purpose of the Study:
- To evaluate the long-term results of heart transplantation.
- To identify prognostic factors influencing survival after heart transplantation.
Main Methods:
- Retrospective analysis of 120 heart transplant patients (1984-1987).
- Assessment of functional status, quality of life, and survival rates.
- Investigation of potential predictors for long-term survival.
Main Results:
- Ten-year survival rate was 48%, with 58 patients surviving over 10 years.
- Leading causes of death included cardiac allograft vasculopathy (39%) and acute rejection (18%).
- Long-term survivors demonstrated good exercise tolerance and preserved left ventricular function.
Conclusions:
- Heart transplantation is a valuable therapeutic option for selected patients.
- Approximately 50% of heart transplant recipients can achieve over 10 years of survival with good functional status.
Objective:
To investigate the long term outcome and prognostic factors after heart transplantation.
Setting:
University hospital.
Subjects:
120 heart transplant patients (98 male, 22 female; underlying disease: dilated cardiomyopathy in 69, coronary artery disease in 42, miscellaneous in nine) who had undergone heart transplantation between October 1984 and October 1987. Immunosuppressive treatment was comparable in all patients and rejection episodes were treated in a uniform manner.
Methods:
Functional status, quality of life, and potential predictors for long term survival were investigated.
Results:
Actuarial survival rates were 65% at five years and 48% at 10 years; 58 patients survived > 10 years. The major causes of death were cardiac allograft vasculopathy (39%), acute rejection (18%), infection (11%), and malignancy (11%). Long term survivors had good exercise tolerance assessed by the New York Heart Association classification: 47 (81%) in grade I/II; 11 (19%) in grade III/IV. Echocardiography showed good left ventricular function in 48 patients. On angiography, severe allograft vasculopathy was present in only 16 patients (28%). Renal function was only slightly impaired, with mean (SD) serum creatinine of 148.5 (84.9) micromol/l. Multiple potential predictors of long term survival were analysed but none was found useful.
Conclusions:
Heart transplantation represents a valuable form of treatment. Survival for more than 10 years with a good exercise tolerance and acceptable side effects from immunosuppression can be achieved in about 50% of patients.