Cardiac transplantation--the London experience

One hundred and forty-eight patients have undergone cardiac transplantation at Harefield Hospital since February 1980. The first 39 patients received an immunosuppressive regime of Azathioprine and oral steroids, resulting in a high incidence of infection and a survival rate at one year of 50%. Since September 1982, a combination of Azathioprine/Cyclosporine with minimal or no steroids has been employed. There have been 28 deaths in patients on the latter regime, resulting in an 82% survival rate at one year. Infection has been significantly reduced and 97% of rejection episodes have been successfully treated. Three patients have developed lymphoproliferative disease resolving on a reduction of immunosuppression. To date, there has been no evidence of chronic rejection in these patients. The elimination of oral steroids has improved both the survival and quality of life of patients after cardiac transplantation and may enable the scope of patients considered for transplantation to be widened.