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Published on: July 18, 2014
Heart transplantation. A retrospective analysis of the long-term results
Suk Jung Choo1, Jae Joong Kim, Sang Pil Kim
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138- 736, Korea.
Insights
This study on heart transplantation found that long-term survival rates were good, with 84% surviving 7 years. Complications were mainly related to immunosuppressive drugs, indicating areas for future improvement in patient outcomes.
Area of Science:
- Cardiology
- Transplantation Surgery
- Immunology
Background:
- Long-term outcomes of orthotopic heart transplantation (OHT) demonstrate significant institutional variability.
- Patient pre-operative status significantly impacts post-transplant recovery and functional class.
Purpose of the Study:
- To evaluate factors influencing long-term survival and complications following orthotopic heart transplantation.
- To compare outcomes between standard and bicaval surgical techniques in OHT.
Main Methods:
- Retrospective analysis of 112 OHT patients between November 1992 and July 2003.
- Comparison of standard versus bicaval surgical techniques.
- Assessment of survival rates, graft vascular disease (GVD)-free survival, and complication incidence.
Main Results:
- 7-year survival rate post-OHT was 84%, with 98 patients alive at a mean follow-up of 51.8 months.
- Graft vascular disease (GVD)-free survival at 3 and 5 years was 96% and 83%, respectively.
- Infection was the leading cause of death (n=4), followed by rejection (n=3) and malignancy (n=2).
Conclusions:
- Orthotopic heart transplantation achieved favorable long-term survival rates, exceeding some Western country benchmarks.
- Immunosuppressive drug-related complications represent a key area for optimizing long-term OHT patient management.
- The observed GVD-free survival rate suggests potential for further research and improvement.
Abstract:
Long-term results of orthotopic heart transplantation vary among different institutions. The purpose of the present study was to assess the factors, which might affect long-term survival and complications. Between November 1992 and July 2003, 112 heart transplantations (M/F=89:23) were performed. The standard technique was used in the first 57 patients and the bicaval technique in the latter 55 patients. Indications for transplantation in decreasing order of frequency were dilated cardiomyopathy (75%), ischemic cardiomyopathy (7%), and others (18%). The mean follow up duration was 51.8 +/- 31.3 months with 98 patients remaining alive. Preoperatively, all patients were either in NYHA functional class III or IV. Postoperatively, all patients showed improvement to functional class II or I, except 3 patients that remained in NYHA class III. The mean number of rejection cases within the first year was 0.6 +/- 0.8, with humoral rejection noted in 3 cases. The graft vascular disease (GVD)-free survival at 3 and 5 years was 96% and 83%, respectively. The 7-year survival after heart transplantation was 84%. There were 16 deaths, of which infection (n=4) was the most common followed by rejection (n=3), and malignancy (n=2). The present long-term results, were relatively superior to those seen in western countries. The relatively low GVD-free survival rate is thought to have contributed. The complications encountered after transplantation were mostly immunosuppressive drug related, suggesting further potentials for improvement in long-term survival.
