Related Experiment Videos
[Causes of failure analysis after cardiac transplantation. From a consecutive series of 91 cases]
J Ninet1, M Vigneron, A el Kirat
1Service de chirurgie thoracique et cardiovasculaire C, Hôpital Cardiologique, Bron.
Insights
Cardiac transplantation outcomes are encouraging, with 77% of survivors asymptomatic after 19 months. Acute rejection and transplant dysfunction remain key challenges in early cardiac transplant mortality.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunosuppression
Background:
- Cardiac transplantation is a critical treatment for end-stage heart failure.
- Understanding outcomes and complications is vital for improving patient survival.
- Early and late post-transplant management strategies significantly impact results.
Purpose of the Study:
- To evaluate the early and medium-term outcomes of cardiac transplantations.
- To identify the primary indications and patient demographics for cardiac transplants.
- To assess the efficacy of the immunosuppressive protocol and complication rates.
Main Methods:
- Retrospective analysis of 93 cardiac transplantations in 91 patients (1987-1989).
- Indication analysis included dilated and ischemic cardiomyopathy, valvular, and congenital heart disease.
- Postoperative immunosuppression utilized triple therapy: Ciclosporine, Azathioprine, and Prednisone.
Main Results:
- Early adult mortality was 10.7%, with 8% in elective cases. Major infectious complications occurred in 11% of patients.
- Forty-four percent of patients experienced no rejection issues, monitored via endomyocardial biopsy and echocardiography.
- Seventy-seven percent of survivors were asymptomatic at an average 19-month follow-up, with 7 late deaths.
Conclusions:
- Acute rejection and transplant dysfunction are primary causes of early cardiac transplant mortality.
- Medium-term results for cardiac transplantation are highly encouraging, despite uncertain long-term prognosis.
- Optimized immunosuppression and vigilant monitoring are crucial for successful cardiac transplant outcomes.
Abstract:
Ninety-three cardiac transplantations were carried out in 91 patients (2 retransplantations) between March 1st 1987 and November 1st 1989, in 84 adults and 7 children under 15 years of age. The indications were dilated cardiomyopathy (48%), ischemic cardiomyopathy (35%), decompensated valvular heart disease (11%), congenital heart disease (3%) and two cases of Uhl's anomaly. Twelve patients underwent transplantation after external circulatory assistance (13%), 11 patients after inscription on the list of extreme emergencies, and 68 on an elective basis (74%). The postoperative immunosuppressive protocol was triple therapy: Ciclosporine, Azathioprine and Prednisone. Three of the children died. The early adult mortality was 9 cases (10.7%). It was 8% in patients operated electively. Major infectious complications occurred in 10 patients (11%). Rejection was looked for by systematic endomyocardial biopsy and echocardiography. Three hundred and forty-nine biopsies were made. Thirty-five patients (44%) had no problems of rejection. Seventy-nine patients have now been followed up for an average of 19 months. There were 7 late deaths. Seventy seven per cent of the survivors are asymptomatic. Acute rejection and transplant dysfunction were the two main causes of early mortality after cardiac transplantation. Although the long-term prognosis is uncertain, the medium-term results are very encouraging.