Thirty years of cardiac transplantation at Stanford university.

BACKGROUND The experience with 30 years of cardiac transplantation at Stanford University Medical Center was reviewed. A total of 954 transplants were performed in 885 patients. Patients were divided into 3 groups based on immunosuppression received: group I, no cyclosporine (INN: ciclosporin) (n = 201) (January 1968-November 1980); group II, cyclosporine (n = 248) (December 1980-June 1987); and group III, cyclosporine + OKT3 (n = 436) (July 1987-March 1998). RESULTS The 1-, 5-, and 10-year actuarial survivals were 68%, 41%, and 24% (group I); 80%, 57%, and 37% (group II); and 85%, 68%, and 46% (group III) (I vs II, P <.01; I vs III, P <.005; and II vs III, P <.005). The 1-, 5-, and 10-year actuarial death rates from rejection were 8%, 12%, and 14% (group I); 5%, 7%, and 7% (group II); and 2%, 5%, and 5% (group III) (I vs II, P = not significant; I vs III, P <.005; and II vs III, P <.005). The 1-, 5-, and 10-year actuarial death rates from infection were 25%, 43%, and 50% (group I); 8%, 17%, and 29% (group II); and 6%, 11%, and 16% (group III) (I vs II, P <.005; I vs III, P <.005; and II vs III, P <.05). The 1-, 5-, and 10-year actuarial death rates from graft coronary artery disease were 0%, 5%, and 13% (group I); 0%, 12%, and 19% (group II); and 1%, 6%, and 9% (group III) (I vs II, P <.01; I vs III, P <.005; and II vs III, P = not significant). There have been 69 retransplants in 67 patients with 1-, 5-, and 10-year actuarial survivals of 49%, 27%, and 15%, respectively. CONCLUSIONS The evolution of 3 decades of experience with cardiac transplantation has resulted in improved overall survival. The incidence of rejection and of death from infection and graft coronary artery disease have decreased over time, primarily as a result of improvements in immunosuppression and in the prevention and treatment of infection. Continued advances in perioperative management and the development of more specific, less toxic immunosuppressive agents could further refine this initial experience and improve the survival and quality of life of patients after cardiac transplantation.

[1]  W. A. Neely,et al.  Practical methods of homologous cardiac transplantation. , 1959, The Journal of thoracic surgery.

[2]  V. Starnes,et al.  Prophylactic OKT3 used as induction therapy for heart transplantation. , 1989, Circulation.

[3]  S. Hunt,et al.  A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients. , 1993, The New England journal of medicine.

[4]  D. Loisance,et al.  Orthotopic cardiac transplantation with direct caval anastomosis: is it the optimal procedure? , 1995, The Journal of thoracic and cardiovascular surgery.

[5]  E. Stinson,et al.  Hemodynamic observations in the early period after human heart transplantation. , 1975, The Journal of thoracic and cardiovascular surgery.

[6]  W. Baumgartner,et al.  Distant heart procurement for transplantation. , 1979, Surgery.

[7]  E. Stinson,et al.  [Use of antithymocyte globulin in human heart transplantation]. , 1972, Klinicheskaia meditsina.

[8]  N. Shumway,et al.  LONG-TERM SURVIVAL OF CARDIAC HOMOGRAFTS. , 1965, Surgery.

[9]  E. Thorsby,et al.  [One year experience with cyclosporin A in clinical heart transplantation]. , 1985, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[10]  C. P. Bailey,et al.  Complete homologous heart transplantation. , 1953, A.M.A. archives of surgery.

[11]  R. Popp,et al.  Sensitivity and specificity of diastolic indexes for rejection surveillance: temporal correlation with endomyocardial biopsy. , 1991, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[12]  S. Hunt,et al.  Methotrexate or total lymphoid radiation for treatment of persistent or recurrent allograft cellular rejection: a comparative study. , 1997, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[13]  E. Stinson,et al.  Cardiac transplantation in man , 1969 .

[14]  E. Gehan.  A GENERALIZED WILCOXON TEST FOR COMPARING ARBITRARILY SINGLY-CENSORED SAMPLES. , 1965, Biometrika.

[15]  V. Starnes,et al.  Eight-year results of cyclosporine-treated patients with cardiac transplants. , 1990, The Journal of thoracic and cardiovascular surgery.

[16]  J. Schroeder,et al.  Cardiac Transplantation in Man. IV. Early Results , 1969, Annals of Surgery.

[17]  F. Ederer,et al.  Maximum utilization of the life table method in analyzing survival. , 1958, Journal of chronic diseases.

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

[19]  N. Shumway,et al.  Studies on orthotopic homotransplantation of the canine heart. , 1960, Surgical forum.

[20]  E. Stinson,et al.  Percutaneous transvenous endomyocardial biopsy. , 1973, JAMA.

[21]  P M Portner,et al.  Isolated left ventricular assist as bridge to cardiac transplantation. , 1988, The Journal of thoracic and cardiovascular surgery.

[22]  P E Oyer,et al.  Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids. , 1987, Annals of internal medicine.

[23]  V. Starnes,et al.  Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis. , 1989, JAMA.

[24]  D. Harrison,et al.  Initial clinical experience with heart transplantation. , 1968, The American journal of cardiology.