Survival benefits of heart and lung transplantation.

OBJECTIVE Heart and lung transplantation has gained acceptance as therapy for end-stage cardiac and pulmonary failure. The early and intermediate survival benefits of one center's 10-year experience with 177 patients undergoing thoracic transplantation were examined. SUMMARY BACKGROUND DATA As experience in cardiac and pulmonary transplantation has increased, improvements in patient selection, organ preservation, preoperative support, and perioperative care have significantly reduced the early threats to patient survival. Graft dysfunction due to chronic rejection appears to be the main risk for longer-term survival, and data compiled by the United Network for Organ Sharing (UNOS) indicate a 70% 5-year survival for heart transplants and a 50% 5-year survival for lung transplant recipients. METHODS The medical records of 120 heart recipients, 52 lung transplant recipients, and 5 heart-lung recipients were reviewed. Cumulative survival estimates were made using Kaplan-Meier analysis. The etiologies of operative and long-term mortality in each transplant population were identified. A comparison of long-term survival after heart transplantation versus coronary revascularization in a group of patients with ischemic cardiomyopathy was performed. RESULTS Operative mortality in both the cardiac and pulmonary transplant recipients was 8%. From 1990 to 1995, 70 consecutive adult cardiac transplant procedures were performed without an operative mortality. Three of five patients survived heart-lung transplantation. The extended actuarial survival rate at 5 years was 80% for the cardiac transplant recipients. The 2-year actuarial survival rate for the lung transplant recipients was 88%. Graft dysfunction was the most common cause of operative mortality in the heart transplant group whereas infection was responsible for most of the operative mortality after lung transplantation. CONCLUSIONS Cardiac and pulmonary transplantation can be applied to morbidly ill patients with excellent operative and intermediate-term survival.

[1]  S. Hunt,et al.  Cardiac transplantation: The Stanford experience in the cyclosporine era , 1994 .

[2]  P. Doubilet,et al.  Effects of heart rate on ventricular size, stroke volume, and output in the normal human fetus: a prospective Doppler echocardiographic study. , 1987, Circulation.

[3]  P. Macdonald,et al.  Initial steroid-free versus steroid-based maintenance therapy and steroid withdrawal after heart transplantation: two views of the steroid question. , 1992, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[4]  G. Patterson,et al.  Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation , 1995 .

[5]  G. Patterson,et al.  Donor lung procurement: assessment and operative technique. , 1993, The Annals of thoracic surgery.

[6]  A. Çobanoğlu,et al.  Cardiac allografts from high-risk donors: excellent clinical results. , 1994, The Annals of thoracic surgery.

[7]  H. Valantine,et al.  Recent advances in cardiac transplantation. , 1995, The New England journal of medicine.

[8]  S. Hunt,et al.  Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. , 1982, The New England journal of medicine.

[9]  D. Driscoll,et al.  Cardiac transplantation: recipient selection, donor procurement, and medical follow-up. A statement for health professionals from the Committee on Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. , 1992, Circulation.

[10]  G. Patterson,et al.  A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation. , 1993, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[11]  O H Frazier,et al.  Multicenter clinical evaluation of the HeartMate 1000 IP left ventricular assist device. , 1992, The Annals of thoracic surgery.

[12]  P. Reddy,et al.  Reversibility of pulmonary hypertension in congestive heart failure patients evaluated for cardiac transplantation: comparative effects of various pharmacologic agents. , 1991, American heart journal.

[13]  L. Yeatman,et al.  Effect of pravastatin on outcomes after cardiac transplantation. , 1995, The New England journal of medicine.

[14]  P J Hendry,et al.  First successful bridge to cardiac transplantation using direct mechanical ventricular actuation. , 1991, The Annals of thoracic surgery.

[15]  W. White,et al.  Coronary artery bypass in patients with severely depressed ventricular function. , 1993, The Annals of thoracic surgery.