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[Current state in heart transplantation]
K Yasuda1, K Ishii, M Watanabe
1Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan.
Insights
Global heart transplantation data until 1993 shows coronary artery disease and cardiomyopathy as primary indications. Survival rates improved significantly after 1982, but challenges remain for elderly, pediatric, and retransplantation patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Context:
- The International Society for Heart and Lung Transplantation Registry provides global data on organ transplantation.
- Heart transplantation procedures have been performed worldwide since the registry's inception.
- Donor heart shortages impact the overall number of heart transplantations performed annually.
Purpose:
- To analyze global heart transplantation statistics up to 1993.
- To identify primary indications for adult heart transplantation.
- To evaluate actuarial survival rates and factors influencing outcomes.
Summary:
- Until 1993, over 26,000 heart transplantations were performed globally, with coronary artery disease (47.2%) and cardiomyopathy (43.5%) as leading causes.
- Actuarial survival rates show significant improvement post-1982, with 3-year survival increasing from 40% to 75%, coinciding with the introduction of cyclopropane.
- Outcomes are poorer for patients over 65, pediatric patients under one year, and heart retransplantations. Mechanical assist devices are used as a bridge to transplantation due to donor heart scarcity.
Impact:
- Highlights the substantial progress in heart transplantation survival rates.
- Identifies specific patient demographics with reduced outcomes, suggesting areas for future research and clinical focus.
- Underscores the ongoing challenge of donor organ availability and the role of mechanical circulatory support.
Abstract:
The Registry of the International Society for Heart and Lung Transplantation reported that 31,157 transplantations were performed throughout the world until 1993, including 26,704 heart transplantations, 1,567 heart-lung transplantations, 1,943 single lung transplantations and 943 bilateral or double lung transplantations. Heart transplantations were carried out at two hundred fifty-one institutes in the world and more than 3,000 patients received heart transplantations every year. The number of heart transplantations, however, became plateau in 1988 and since 1991 the number of operations rather decreased because of the shortage of donor hearts. Indications for adult heart transplantation include coronary artery disease in 47.2% and cardiomyopathy in 43.5%, representing the most frequently reported indications. Retransplantations represent only 2.3% of the total heart transplantations. The results for heart transplantation reveal that the 1, 3, 5, and 12-year actuarial survival are 80%, 72%, 64% and 40%, respectively. Comparing the data before and after 1982 when cyclopropane was introduced for transplantations, a substantial improvement in actuarial survival is obtained. For instance, 3-year actuarial survival before 1981 was 40% whereas since 1982 3-year actuarial survival is improved up to 75%. However, the patients in the older age (more than 65 years old) and pediatric patients, particularly less than one year old, have a significant reduction in outcome compared with younger adult patients and the outcome of heart retransplantation was still poor. Because of the shortage of donor heart quite a large number of patients develop hemodynamic deteriorations before transplantation and mechanical assist device is one of strategies to treat these patients as bridge to heart transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)