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[Morbidity and mortality after heart transplanation]
M J Rebocho1, C Aguiar, J Queiroz e Melo
1Serviço de Cirurgia Cardiotorácica, Hospital de Santa Cruz, Carnaxide, Portugal.
Insights
Heart transplantation offers a valid treatment for end-stage heart failure, with most long-term survivors experiencing good quality of life. Key challenges include managing infection, rejection, and complications from immunosuppression.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation is a critical intervention for end-stage heart failure.
- Evaluating long-term outcomes is essential for refining patient care and management strategies.
Purpose of the Study:
- To assess the morbidity and mortality rates following heart transplantation.
- To analyze the causes of death and complications in patients undergoing heart transplantation at Santa Cruz Hospital.
Main Methods:
- A retrospective analysis of 113 patients who underwent heart transplantation between February 1986 and December 2000.
- Kaplan-Meier survival analysis was used to calculate survival rates at 12 months, 5 years, and 10 years.
- Morbidity, causes of mortality, and quality of life (functional and employment status) were evaluated.
Main Results:
- Actuarial survival rates were 82.2% at 12 months, 64.6% at 5 years, and 45.3% at 10 years, with a maximum survival of 14.7 years.
- Infections were the leading cause of early mortality, while allograft vasculopathy and malignancy were major causes of late mortality.
- Common morbidities included infections (35.4%), rejection episodes, tumors, allograft vasculopathy, and significant side effects of chronic immunosuppression such as hypertension (50%) and dyslipidemia (31%).
Conclusions:
- Cardiac transplantation remains a viable treatment option for end-stage heart failure.
- Long-term survivors generally achieve a good quality of life, comparable to the general population.
- Ongoing monitoring for infection, rejection, and immunosuppression-related complications is crucial for optimizing patient outcomes.
Aim:
To evaluate the morbidity and mortality after heart transplantation in the patients treated at Santa Cruz Hospital.
Methods:
Between February 1986 and December 2000, 113 patients underwent orthotopic heart transplantation at Santa Cruz Hospital. Actuarial survival rates at 12 months, 5 and 10 years after surgery were calculated (Kaplan-Meier analysis). We identified the causes of death and evaluated their relation with time after transplantation. Quality of life after surgery was assessed by functional status and employment status. Main causes of morbidity were identified: infection, rejection, tumors, allograft vasculopathy and side effects of chronic immunosuppression.
Results:
Eighty-one patients (71.7%) were discharged alive after transplantation. In this group, actuarial survival was 82.2% at 12 months, 64.6% at 5 years and 45.3% at 10 years. Maximal survival was 14.7 years. In the immediate postoperative period, the main causes of mortality were procedure-related ou primary cardiac complications. Infection was the most common cause of death in the first 3 months after transplantation. Allograft vasculopathy was the main cause of death in the group of patients surviving the first year. Malignancy was another cause of late mortality. Clinically relevant non-fatal infections occurred in 35.4% of our patients. Overall, 108 mild rejection episodes were diagnosed in 55 patients, 82 moderate rejection episodes in 52 patients and 9 severe rejections in 8 patients. Eleven non-fatal tumors were detected in 10 patients. In the group of patients who have underwent at least one coronary arteriography, 34.6% present allograft vasculopathy. Clinically relevant complications of chronic immunosuppression were: hypertension in 50% patients; dyslipidemia in 31%; osteoporosis in 19.5%; diabetes mellitus in 15%; end-stage renal failure in 3.5%.
Conclusion:
Cardiac transplantation is a valid treatment for end-stage heart failure. Most patients surviving long-term are in good physical status and their quality of life is comparable to that of the general population.