Heart transplantation continues to be the treatment of choice for refractory cases of heart failure (1,2)
- introduction of cyclosporin and other advances in the 1980s radically improved the prognosis of these patients and led to prolonged survival and widespread use of the technique
- median survival of transplanted patients is currently somewhat higher at 10 years, and about 14 years for those who survive the first year, which is the year with the highest incidence of complications (3)
Advances implemented in recent decades in the management and follow-up of patients with heart transplantation have allowed prolonged survival rates to be obtained
- at present, 20-year survival rates in the national and international registries are >20% (3)
After the first year
- annual mortality rate of 3.5% in the Registry of the International Society for Heart and Lung Transplantation (ISHLT)
- the mortality of the general population between 55 and 60 years of age is approximately 0.5%
Factors associated with longer survival include
- low recipient age,
- lower body mass index at the time of transplantation,
- nonischemic diagnosis prior to transplantation,
- lower graft ischemia time
Large series with 15 years of follow-up report the causes of death as (4):
- malignancies (35.8%),
- allograft vasculopathy (24.7%)
- infections caused by microorganisms other than cytomegalovirus (8.6%)
Reference:
- Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:1988-2016.
- Mancini D, Lietz K. Selection of cardiac transplantation candidates in 2010. Circulation. 2010;122:173-83
- Stehlik J, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dobbels F, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th Official Adult Heart Transplant Report-2012. J Heart Lung Transplant. 2012;31:1087-95.
- Roussel JC, Baron O, Perigaud C, Bizouarn P, Pattier S, Habash O, et al. Outcome of heart transplant 15 to 20 years ago: graft survival, post-transplant morbidity, and risk factors for mortality. J Heart Lung Transplant. 2008;27:486-93.