[Heart transplantation in the era of cyclosporin]

In a five-year period from February 1984, 76 orthotopic heart transplantations were performed in the most extensive heart transplantation programme in the Harvard Medical School in Boston, Massachusetts. The average age of the patients was 43 years (range 14-61 years) and the sex distribution was 55 men/21 women. Cardiomyopathy and ischaemic heart disease were the commonest indications for transplantation. The actuarical survival was 84% after one year, 81% after two years and 76% after five years. When the operative lethality is excluded, the one-year survival was 91%, the two-year survival 88% and the five-year survival 82%. Six operative deaths occurred within the first 30 days and seven late deaths, five of these from acute rejection and two as a result of transplant atherosclerosis. No deaths were due to infection. Twelve patients developed 14 general surgical complications and laparotomy proved necessary in ten cases. One of the patients died from haemorrhagic pancreatitis and the remainder had no sequelae. An association was found between tissue type compatibility (human leukocyte antigen (HLA)) between donor and recipient and the occurrence of steroid resistant rejections.