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Heart transplantation: 25 years' single-centre experience
Giuseppe Bruschi1, Tiziano Colombo, Fabrizio Oliva
1Cardiology and Cardiac Surgery Department bCardiothoracic Anesthesia and Intensive-care, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
Insights
Heart transplantation (HTx) offers effective treatment for end-stage heart disease. This 25-year single-centre experience shows that careful patient selection, advanced care, and teamwork yield excellent long-term survival rates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- Heart transplantation (HTx) is a critical therapy for end-stage heart disease.
- Significant advancements in surgical techniques and postoperative care have occurred over decades.
Purpose of the Study:
- To report the 25-year single-centre experience with orthotopic heart transplantation (HTx).
- To analyze outcomes, survival rates, and causes of mortality in adult HTx recipients.
Main Methods:
- Analysis of 878 primary adult orthotopic heart transplants performed between November 1985 and the study period.
- Exclusion of re-transplantation cases and pediatric patients (<15 years).
Main Results:
- Hospital mortality was 11.6%, with early graft failure as the leading cause.
- Actuarial survival reached 78.1% at 5 years, 63.8% at 10 years, and 47.5% at 15 years.
- Long-term survival is challenged by coronary allograft vasculopathy and malignancies; 66.9% freedom from CAV at 10 years.
Conclusions:
- Improvements in HTx are attributed to enhanced surgical methods and patient care.
- Careful patient selection, precise follow-up, and multidisciplinary collaboration are key to achieving excellent long-term results.
- The study highlights the importance of managing complications like coronary artery vasculopathy and neoplasms post-transplant.
Objectives:
Heart transplantation (HTx) is still one of the most effective therapies for end-stage heart disease for patients with no other medical or surgical therapy. We report the results of our 25-year orthotropic HTx single-centre experience.
Methods:
From November 1985, 905 orthotopic heart transplants have been performed at our centre. We exclude from the present analysis 13 patients who underwent re-transplantation and 14 pediatric cases (age at HTx <15 years).
Results:
The present study collected the data of 878 primary adult orthotopic HTx performed at our centre. Mean age at HTx was of 49.6 ± 11.6 years. Mean donor age was 36.9 ± 14.8 years. Hospital mortality was 11.6% (102 patients), early graft failure was the principal cause of death (58 patients) followed by infections (18 cases) and acute rejection (7 patients). Overall actuarial survival was 78.1% at 5 years and 63.8% and 47.5%, respectively, at 10 and 15 years from HTx. Mean survival was 10.74 years; 257 late deaths were reported (33.1%); main causes were neoplasm in 83 patients, and cardiac causes included coronary allograft vasculopathy in 78 patients. Freedom from any infection at 5, 10 and 15 years was 52.2, 44.1 and 40.1%, respectively. Freedom from rejection at 5 years was 36.2%, with 493 patients experiencing at last one episode of rejection, the majority occurring during the first 2 months after transplantation. The long-term survival of HTx recipients is limited in large part by the development of coronary artery vasculopathy and malignancies. In our experience freedom from coronary allograft vasculopathy at 10 years was 66.9%, and 85 patients underwent percutaneous coronary revascularization. In our study population, 44 patients experienced posttransplant lymphoproliferative disorder and 91 patients experienced a solid neoplasm, mean survival free from neoplasm was 12.23 years.
Conclusion:
Over the past four decades the field of HTx has evolved considerably, with improvements in surgical techniques and postoperative patients' care. A careful patient selection and treatment of candidates for transplantation as well as accurate clinical follow-up combined with real multidisciplinary teamwork that involved different heart failure specialists, allowed us to obtain our excellent long-term results.
