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CLINICAL STUDY: HEART TRANSPLANT

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

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

^* Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
Department of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA

Manuscript received March 15, 2000; revised manuscript received July 24, 2000, accepted September 14, 2000.

Reprint requests and correspondence: Dr. Ranjit John, Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Milstein Hospital Building 7-435, 177 Fort Washington Avenue, New York, New York 10032
ranjitj{at}pol.net

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 l/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.

Abbreviations and Acronyms   TRCAD = transplant-related coronary artery disease

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