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[Heart transplantation in Norway]
S Simonsen1, A K Andreassen, L Gullestad
1Hjertemedisinsk avdeling, Rikshospitalet, Oslo.
Insights
This study details 16 years of heart transplantation experience in Nordic countries, performing 317 procedures. Survival rates were 85% at one year and 53% at ten years, with younger recipients showing better outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- The Nordic countries initiated heart transplantation in 1983.
- This paper reviews the initial 16 years of heart transplantation experience at Rikshospitalet, Oslo.
Purpose of the Study:
- To present the comprehensive experience and outcomes of heart transplantation performed between 1983 and 1999.
- To analyze patient demographics, indications, immunosuppression protocols, and survival rates.
Main Methods:
- Retrospective analysis of 317 heart transplantations performed from 1983 to 1999.
- Standard triple immunosuppression regimen: ciclosporin, prednisolone, and azathioprine.
- Evaluation of early and late postoperative complications, and causes of death.
Main Results:
- A total of 317 heart transplantations were performed, averaging 23 per year.
- Recipient demographics: 82% male, mean age 47 years, 50% with coronary heart disease.
- One-year and ten-year survival rates were 85% and 53%, respectively.
- Younger recipients (<50 years) and grafts from younger donors (<35 years) correlated with significantly higher survival.
- Common early complications included acute cellular rejection and infections.
- Late mortality was primarily due to transplant-accelerated coronary heart disease and cancer.
Conclusions:
- Heart transplantation is a viable treatment option in the Nordic countries with established survival rates.
- Patient age and donor age are critical factors influencing long-term outcomes.
- Management of postoperative complications and late-term sequelae like cardiac allograft vasculopathy and malignancy is crucial.
Abstract:
The first heart transplantation in the Nordic countries was performed at Rikshospitalet, Oslo in 1983. In this paper, we present our experience with this treatment up to 1999. 317 heart transplantations have been performed, an average of 23 transplantations per year. 82% of the recipients were males; 50% had heart failure due to coronary heart disease. Mean age of the recipients was 47 years (range 1-64). Our indications and contraindications are similar to most other transplantation centres. Triple immunosuppression with ciclosporin, prednisolone and azathioprine have been used as standard treatment. The survival rate after one and ten years are 85% and 53% respectively, with a significantly higher survival rate among recipients younger than 50 at transplantation, especially if the graft was from a donor younger than 35 years. The most common early postoperative complications were acute cellular rejections and infections. Transplant accelerated coronary heart disease and cancer were the main causes of late death. We believe that close co-operation between Riskshospitalet and local centres will provide the best treatment for patients needing a heart transplant.