Factors affecting long-term survival (>10 years) after cardiac transplantation in the cyclosporine era

Ranjit John, Hiranya A. Rajasinghe, Silviu Itescu, Sanjeev Suratwalla, Katherine Lietz, Alan D. Weinberg, Alfred Kocher, Donna M. Mancini, Ronald E. Drusin, Mehmet C. Oz, Craig R. Smith, Eric A. Rose, Niloo M. Edwards

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

OBJECTIVES: The aim of this study was to determine long-term survival >10 years) after cardiac transplantation in the cyclosporine era and identify risk factors influencing long-term survival. BACKGROUND Despite the availability of newer modalities for heart failure, cardiac transplantation remains the treatment of choice for end-stage heart disease. METHODS: Between 1983 and 1988, 195 patients underwent heart transplantation at a single center for the treatment of end-stage heart disease. Multivariable logistic regression analysis of pretransplant risk factors affecting long-term survival after cardiac transplantation included various recipient and donor demographic, immunologic and peritransplant variables. RESULTS: Among the group of 195 cardiac transplant recipients, actuarial survival was 72%, 58% and 39% at 1, 5 and 10 years respectively. In the 65 patients who survived > 10 years, mean cardiac index was 2.9 1/m2 and mean ejection fraction was 58%. Transplant-related coronary artery disease (TRCAD) was detected in only 14 of the 65 patients (22%). By multivariable analysis, the only risk factor found to adversely affect long-term survival was a pretransplant diagnosis of ischemic cardiomyopathy (p = 0.04). CONCLUSIONS: Long-term survivors maintain normal hemodynamic function of their allografts with a low prevalence of TRCAD. It is possible that similar risk factors that lead to coronary artery disease in native vessels continue to operate in the post-transplant period, thereby contributing to adverse outcomes after cardiac transplantation. Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of coronary atherosclerosis and enable long-term survival after cardiac transplantation.

Original languageEnglish (US)
Pages (from-to)189-194
Number of pages6
JournalJournal of the American College of Cardiology
Volume37
Issue number1
DOIs
StatePublished - 2001

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