UZH-Logo

Maintenance Infos

Surviving 20 years after heart transplantation: a success story


Rodriguez Cetina Biefer, Hector; Sündermann, Simon H; Emmert, Maximilian Y; Enseleit, Frank; Seifert, Burkhardt; Ruschitzka, Frank; Jacobs, Stephan; Lachat, Mario L; Falk, Volkmar; Wilhelm, Markus J (2014). Surviving 20 years after heart transplantation: a success story. Annals of Thoracic Surgery, 97(2):499-504.

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.

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.

Citations

9 citations in Web of Science®
11 citations in Scopus®
Google Scholar™

Altmetrics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords: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
Language:English
Date:2014
Deposited On:22 Nov 2013 09:04
Last Modified:05 Apr 2016 17:10
Publisher:Elsevier
ISSN:0003-4975
Additional Information:Rodriguez Cetina Biefer, Hector Sundermann, Simon H Emmert, Maximilian Y Enseleit, Frank Seifert, Burkhardt Ruschitzka, Frank Jacobs, Stephan Lachat, Mario L Falk, Volkmar Wilhelm, Markus J Netherlands The Annals of thoracic surgery Ann Thorac Surg. 2014 Feb;97(2):499-504. doi: 10.1016/j.athoracsur.2013.08.040. Epub 2013 Oct 17.
Publisher DOI:https://doi.org/10.1016/j.athoracsur.2013.08.040
PubMed ID:24140213

Download

Full text not available from this repository.
View at publisher

TrendTerms

TrendTerms displays relevant terms of the abstract of this publication and related documents on a map. The terms and their relations were extracted from ZORA using word statistics. Their timelines are taken from ZORA as well. The bubble size of a term is proportional to the number of documents where the term occurs. Red, orange, yellow and green colors are used for terms that occur in the current document; red indicates high interlinkedness of a term with other terms, orange, yellow and green decreasing interlinkedness. Blue is used for terms that have a relation with the terms in this document, but occur in other documents.
You can navigate and zoom the map. Mouse-hovering a term displays its timeline, clicking it yields the associated documents.

Author Collaborations