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Heart and heart-lung transplantation at the Johns Hopkins Hospital
D L Johnson1, W A Baumgartner, B A Reitz
1Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Heart transplantation survival rates are 85% at 1 year and 66% at 5 years. Older donor age and CMV infection predict coronary artery disease in heart transplants.
Area of Science:
- Cardiology
- Transplant Surgery
- Immunology
Background:
- Since 1983, 120 heart and 18 heart-lung transplants performed.
- Donor availability increased with relaxed donor criteria.
- Current immunosuppression uses a 3-drug protocol: Cyclosporine (CsA), Azathioprine (Aza), and Prednisone (P).
Purpose of the Study:
- To report institutional outcomes for heart and heart-lung transplantation.
- To identify risk factors for cardiac allograft vasculopathy.
- To highlight challenges in heart-lung preservation.
Main Methods:
- Retrospective review of 120 heart and 18 heart-lung transplant recipients.
- Analysis of patient survival rates at 1 and 5 years.
- Statistical analysis to identify predictors of coronary artery disease.
Main Results:
- 1-year heart transplant survival: 85%; 5-year: 66%.
- 1-year heart-lung transplant survival: 53%.
- Older donor age and Cytomegalovirus (CMV) infection are significant predictors of coronary artery disease in heart grafts.
Conclusions:
- Heart transplantation demonstrates favorable survival rates.
- Coronary artery disease in grafts is a significant long-term concern.
- Improved heart-lung preservation techniques are needed to optimize donor organ utilization.
Abstract:
Since 1983, 120 patients have undergone heart transplantation and 18 patients have had heart-lung transplants at our institution. Transplantation is limited only by donor referrals but relaxation of donor criteria has increased donor availability. Immunosuppression currently consists of a 3-drug protocol of CsA, Aza, and P. Our current 1- and 5-year survival rates for heart transplants are 85% and 66%, respectively. The 1-year survival for heart-lung transplantation is 53%. Research continues in many areas of transplantation. The development of coronary artery disease in grafted hearts remains a problem. We have found that older donor age and Cmv infection are significant predictors of developing coronary disease. Routine successful extended heart-lung preservation has been difficult to achieve. A successful technique of prolonged preservation would allow for better matching, reduced logistics, and, potentially, increased numbers of donor organs.