Surviving 20 years after heart transplantation: a success story.

Abstract

BACKGROUND:

We report the long-term outcomes of patients who survived 20 years or greater after heart transplantation.

METHODS:

From 1985 to 2012, 386 patients underwent heart transplantation at our institution. Patient data were analyzed retrospectively for transplants performed from 1985 to 1991. The Kaplan-Meier method was used for survival analyses.

RESULTS:

In total, 133 patients were included. The mean age of the 20-year survivors at transplant was 43.6±11.4 years. The mean ischemic time was 71.2±34.0 minutes. The overall actuarial survival rates at 1, 10, and 20 years were 82.7%, 63.9%, and 55.6%, respectively. The most common causes of death were graft rejection (21%), malignancy (21%), infection (15%), and cardiac allograft vasculopathy (CAV, 14%). After 1, 10, and 20 years, the rejection-free survival rates were 19%, 13%, and 13%, respectively, and the malignancy-free survival rates were 99%, 67%, and 61%. The CAV-free survival rates were 97%, 48%, and 42%, respectively, and the infection-free survival rates were, respectively, 70%, 15%, and 14%. The actuarial diabetes-free survival rates at 1, 10, and 20 years were 85%, 80%, and 79%, respectively. Actuarial hypertension-free survival was 56% after 1 year and 26% after 10 and 20 years. Two patients received a second heart transplant.

CONCLUSIONS:

A remarkable number of patients survived 20 years or greater after heart transplantation, confirming the procedure as the gold standard for end-stage heart failure. Complications resulting from immunologic events and immunosuppressive therapy determine post-transplant mortality and morbidity. Due to improvements in immunosuppressive management in recent years, long-term survival is likely to increase.

• Authors: Hector Rodriguez Cetina Biefer, Simon H Sündermann, Maximilian Y Emmert, Frank Enseleit, Burkhardt Seifert, Frank Ruschitzka, Stephan Jacobs, Mario L Lachat, Volkmar Falk, Markus J Wilhelm
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 97 Issue 2 Pg. 499-504 (Feb 2014) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 24140213 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Child
• Female
• Follow-Up Studies
• Heart Transplantation (adverse effects, mortality)
• Humans
• Incidence
• Male
• Middle Aged
• Postoperative Complications (epidemiology, etiology)
• Retrospective Studies
• Survival Rate
• Time Factors
• Treatment Outcome
• Young Adult