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Characteristics of patients surviving more than ten years after cardiac transplantation
W M DeCampli1, H Luikart, S Hunt
1Department of Cardiothoracic Surgery, Stanford University Medical Center, Calif, USA.
Insights
Long-term heart transplant recipients (over 10 years) show acceptable health and quality of life, though infection risk increases. Key survival factors include transplant age, illness duration, CMV infection, and ejection fraction.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- Long-term outcomes and quality of life beyond 10 years require further investigation.
Purpose of the Study:
- To evaluate the clinical status and quality of life in patients surviving over 10 years post-heart transplantation.
- To identify factors associated with long-term survival after heart transplantation.
Main Methods:
- Retrospective review of 40 patients with >10 years follow-up using transplant database.
- Prospective patient examinations, cardiac catheterization, exercise testing, and validated health status questionnaires (Nottingham Health Profile, General Well Being).
- Cox proportional hazards model for survival analysis.
Main Results:
- 51% of patients experienced graft coronary artery disease; infection rates were higher compared to shorter-term survivors (p=0.005).
- Graft function remained well-preserved; functional status and perceived quality of life were generally acceptable.
- Leading causes of death included coronary artery disease (7/14) and infection (4/14).
Conclusions:
- Heart transplantation offers acceptable long-term medical condition, functional status, and quality of life into the second decade.
- Age at transplantation, preoperative illness duration, postoperative cytomegalovirus infection, and ejection fraction at 12 months are critical for survival.
Abstract:
The clinical status and quality of life of 40 patients who lived or are still alive more than 10 years after transplantation at our institution were reviewed with the use of our transplant database, prospective patient examinations, cardiac catheterization, and exercise testing. Patient-perceived health status was determined with use of the Nottingham Health Profile and General Well Being examinations. Factors associated with longevity were determined by a Cox proportional hazards model. Twenty-six patients are alive and 14 have died. The mean age at transplant was 32.4 +/- 12 years and the current age (or age at death) is 46.1 +/- 12.8 years. Actuarial freedom from rejection was similar to that of patients surviving less than 10 years (p = 0.8), but freedom from all types of infection was less (p = 0.005). Immunosuppressive drugs include cyclosporine (11/26 patients), azathioprine (24/26), and prednisone (26/26, mean dose 12.7 mg/day). Catheterization hemodynamic data show well-preserved graft function at a mean follow-up of 11.7 +/- 3.3 years. Graft coronary artery disease prevalence is 51.0% +/- 8%. Exercise test results are as follows: duration 8.7 +/- 3.5 minutes (range 2 to 16 minutes), maximum heart rate/expected rate 77.3% +/- 11% (50% to 92%), maximum systolic blood pressure 171 +/- 23 mm Hg (140 to 208 mm Hg), and metabolic equivalents 9.2 +/- 2.3 units (5.5 to 12.9 units), or about 84% of predicted. Mean score on the General Well Being examination was 75.3 +/- 21.6 (normal). Nottingham Health Profile scores were nearly normal, except for in the 50- to 64-year-old age group in categories of mobility, pain, sleep quality, and energy level. Causes of death were coronary artery disease in 7 of 14, infection in 4 of 14, lymphoma in 1 of 14, and nonlymphoid cancer in 2 of 14. In the Cox regression, variables most associated with survival (t > 2.0, multivariate p = 0.0005) were age at transplantation (t = 3.26), preoperative duration of illness (t = 3.57), postoperative cytomegalovirus infection (t = 2.16), and ejection fraction at 12 months after operation (t = -2.62). We conclude that cardiac transplantation can provide patients with end-stage cardiac failure an acceptable general medical condition, functional status, and perceived quality of life well into the second decade after operation.