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Cardiac transplantation--first year experience in a community hospital: a three year follow-up
D M Gangahar1, S P Liggett, S W Carveth
1Bryan Memorial Hospital, Lincoln, Nebraska 68506-2299.
Insights
This study shows successful cardiac transplantation in a community hospital, with high survival rates and manageable side effects. It demonstrates that heart transplants can be cost-effective, even with fewer cases.
Area of Science:
- Cardiology
- Transplantation Surgery
- Immunosuppression
Background:
- Orthotopic cardiac transplantation is a viable treatment for end-stage cardiac disease.
- Community hospitals can successfully implement heart transplantation programs.
Purpose of the Study:
- To evaluate the outcomes of orthotopic cardiac transplantation in a community hospital setting.
- To assess survival rates, functional status, and side effects of immunosuppressive therapy.
Main Methods:
- Retrospective analysis of ten consecutive patients undergoing orthotopic cardiac transplantation.
- Standard triple immunosuppressive therapy and follow-up for 33-45 months.
- Monitoring for infection, rejection, renal function, and hypertension.
Main Results:
- 100% survival at two years and 90% at three years.
- Survivors achieved New York Heart Association (NYHA) Class I or II functional status.
- High incidence of renal function deterioration and systemic hypertension as side effects of Cyclosporine therapy.
Conclusions:
- Cardiac transplantation can be successfully and cost-effectively performed in community hospitals.
- Renal insufficiency and hypertension are significant long-term side effects of Cyclosporine.
- Careful patient selection and management are crucial for successful outcomes.
Abstract:
This is a report of ten consecutive patients with end-stage cardiac disease treated with orthotopic cardiac transplantation in a community hospital, during the first year of its heart transplantation program. All patients were followed for a minimum of 33 months and a maximum of 45 months with 100% survival at two years and 90% at three years. All survivors are presently in N.Y.H.A. Class I or II. The entire group of patients received the same triple immunosuppressive therapy. The incidence of infection and rejection during the first three months post-transplantation was 0.3 and 0.6 episodes per patient respectively. Every patient developed some degree of deterioration in renal function and 80% of the patients now receive treatment for systemic hypertension. The in-hospital institution cost for the transplant admission varied from $25,084 to $74,164. To date, 30 patients have undergone heart transplantation in our program and 26 are long-term successes. This study again proves that renal insufficiency and hypertension remain the major side effects of Cyclosporine therapy. We further conclude from our experience that cardiac transplantation can be successfully and cost effectively performed in a community hospital even with a somewhat lower caseload.