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Cardiac transplantation at UCLA
A Ardehali1, H Laks, D C Drinkwater
1Department of Surgery, UCLA School of Medicine.
Insights
Heart transplant numbers are rising, but donor organ scarcity remains a challenge. Recent UCLA data shows improved outcomes in heart transplant patients, even with sicker recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation is increasingly common due to broader indications.
- Donor organ scarcity limits the number of procedures performed.
- UCLA has performed 320 adult heart transplants through 1992.
Purpose of the Study:
- To analyze heart transplant outcomes at UCLA.
- To identify factors influencing patient survival and post-transplant complications.
- To evaluate trends in patient outcomes over time.
Main Methods:
- Retrospective analysis of 320 adult heart transplant recipients at UCLA (through 1992).
- Categorization of transplant indications: ischemic cardiomyopathy (54%), dilated cardiomyopathy (33%), and others (4%).
- Assessment of post-transplant outcomes including rejection episodes, infections, mortality, and survival rates.
Main Results:
- 1-year, 3-year, and 5-year survival rates were 84.3%, 74.3%, and 67.5%, respectively.
- Early mortality (30-day) was 5.7%.
- Patients transplanted in 1991-1992 showed improved outcomes (shorter hospital stay, fewer infections/rejections) despite a higher proportion of critically ill patients (UNOS Status 1).
Conclusions:
- Heart transplantation outcomes are improving, with comparable survival for ischemic and dilated cardiomyopathy.
- Survival rates are similar in older (≥60 years) and younger (<60 years) heart transplant recipients.
- Recent advancements in care have led to better patient outcomes, even in critically ill patients.
Abstract:
In the last decade, the number of patients undergoing heart transplantation has steadily increased as a result of expanding indications for cardiac transplantation. The limitation on the number of transplants performed has been the scarcity of donor organs. At UCLA, 320 heart transplant procedures were performed in adults through the end of 1992; 173 patients (54%) underwent transplantation for ischemic cardiomyopathy; 104 (33%) for dilated cardiomyopathy, and 13 (4%) for severe rejection or cardiac allograft vasculopathy. The mean number of rejection episodes and infections per patient per year in the first posttransplant year was 1.28 and 0.58, respectively. Early mortality (30 days) was 5.7%, while 1-, 3-, and 5-year survival rates were 84.3%, 74.3%, and 67.5%, respectively. Survival of patients transplanted for ischemic cardiomyopathy and idiopathic cardiomyopathy was nearly equal. Survival was also comparable in patients aged 60 years and over (n = 71) and those under age 60. We observed improved patient outcome including shorter posttransplant hospital stay, time to extubation, and lower incidences of infections, rejection episodes, and renal failure in patients transplanted in 1991 and 1992. This observation was interesting in view of the increased proportion of critically ill patients in this group (46% UNOS Status 1) compared with patients transplanted in the previous years (30% UNOS Status 1).(ABSTRACT TRUNCATED AT 250 WORDS)