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Cardiac transplantation: five years' activity
Manuel J Antunes1, David Prieto, Emília Sola
1Programa de Transplantação Cardíaca, Centro de Cirurgia Cardiotorácica, Hospitais da Universidade Coimbra, Coimbra, Portugal. antunes.cct.huc@sapo.pt
Insights
The Coimbra University Hospitals heart transplant program achieved 90% one-year and 82% five-year survival rates in its initial five years. These results demonstrate the program
Area of Science:
- Cardiology
- Transplant Surgery
- Immunology
Background:
- The establishment of new heart transplant programs is crucial for expanding access to life-saving treatments.
- Analyzing early outcomes is essential for program refinement and demonstrating efficacy.
Purpose of the Study:
- To evaluate the initial five-year experience of the heart transplant program at Coimbra University Hospitals.
- To assess patient and graft survival rates, complications, and overall program performance.
Main Methods:
- A retrospective analysis of 132 heart transplant recipients between November 2003 and December 2008.
- Data collection included patient demographics, donor characteristics, surgical techniques, immunosuppression protocols, and clinical outcomes.
- Kaplan-Meier survival analysis was used to determine actuarial survival rates.
Main Results:
- Actuarial survival rates at one and five years were 90% and 82%, respectively.
- Early mortality (within 30 days) was 4.5%, primarily due to graft failure and hyperacute rejection.
- Late mortality (after 30 days) was 10%, with cancer and infection being the leading causes. Rejection episodes were managed effectively with immunosuppression adjustments.
Conclusions:
- The Coimbra University Hospitals heart transplant program achieved outcomes comparable to or better than established centers.
- The program has successfully increased the rate of cardiac transplantation in Portugal, exceeding the European average.
- Continuous self-correction based on program experience has been key to its success.
Objective:
To analyze the initial five years experience of the new heart transplant program of Coimbra University Hospitals.
Methods:
Between November 2003 aid December 2008, 132 patients were transplanted, with a mean age of 52.0 years (range 3-71 years), of whom 98 were male (74%). Half of the patients had dilated cardiomyopathy and 33% ischemic cardiomyopathy. The mean age of donors was 31.7 years and 102 were male (77%). Donor hearts were harvested at a distance in 62% of cases. There was a gender mismatch between donor and recipient (F:M) in 19% of cases and ABO blood type disparity (not identical but compatible) in 11%. In all cases we used the technique of total transplantation with bicaval anastomosis, modified in this center. Mean ischemia time was 88.9 +/- 32.2 minutes. All patients received induction therapy with basiliximab and methylprednisolone.
Results:
Six patients (4.5%) died within 30 days or during hospitalization, due to graft failure in four and hyperacute rejection in two. Two patients required prolonged ventilation, ten (8%) required inotropic support for more than 48 hours, and four required pacemaker implantation. Mean hospital stay was 15.6 +/- 15.2 days (median 13 days). Ninety percent of patients (116/129) were maintained on triple immunosuppressive therapy, including cyclosporine, the remainder receiving tacrolimus. In 23 patients it was necessary to change the immunosuppressive regimen due to renal and/or tumoral complications, or humoral rejection. All patients are followed regularly in the Surgical Center. Thirteen patients (10%) died late of cancer (6 patients), infection (4 patients), and pancreatitis, pulmonary hypertension and suicide (one patient each). Twenty-two patients (17%) had 25 episodes of cellular rejection (> or = 2R), with clinical consequences in only one case, and five had humoral rejection (3.9%). No patients died of late rejection, but there is evidence of mild graft vascular disease in one. Actuarial survival (Kaplan-Meier) at one and five years was 90% and 82%, respectively.
Conclusion:
In this initial series of five years we obtained results equivalent to or bette than those in centers with wider and longer experience, aided by self-correction arising from our own experience. This program has increased the rate of cardiac transplantation in Portugal to above the European average.
