Prognosis after cardiac transplantation
- Michael X Pham, MD, MPH
Michael X Pham, MD, MPH
- Medical Director of the Center for Advanced Heart Failure Therapies
- California Pacific Medical Center
Cardiac transplantation remains the treatment of choice for many patients with end-stage heart failure (HF) with severely impaired functional capacity despite optimal medical therapy. Although barriers to long-term survival remain, the outcome among transplant recipients has improved over several decades as a result of careful recipient and donor selection, advances in immunosuppression, and the prevention and treatment of opportunistic infections. (See "Overview of the therapy of heart failure with reduced ejection fraction" and "Indications and contraindications for cardiac transplantation in adults".)
Current survival in adults after orthotopic heart transplantation, retransplantation, and combined organ transplantation will be reviewed here. The data presented are contained in the Adult Heart Report from the Registry of the International Society for Heart and Lung Transplantation (ISHLT), published annually [1-3]. Additional information regarding the indications for cardiac transplantation and treatment following transplantation is presented separately. (See "Indications and contraindications for cardiac transplantation in adults" and "Induction and maintenance of immunosuppressive therapy in cardiac transplantation" and "Acute cardiac allograft rejection: Diagnosis" and "Acute cardiac allograft rejection: Treatment".)
OUTCOME AFTER FIRST HEART TRANSPLANTATION
The most comprehensive information regarding patient survival after thoracic organ transplantation comes from data collected by the International Society for Heart and Lung Transplantation (ISHLT). This database includes data from over 100,000 cardiac transplants performed worldwide since 1982 by more than 380 transplant programs. Although center-specific data may vary, survival figures from data like the ISHLT registry are often quoted when providing patients with realistic expectations regarding survival after transplantation. For additional information, see http://www.ishlt.org/registries/slides.asp?slides=heartLungRegistry.
Survival — In a registry report, the median survival for adult and pediatric heart transplants performed between 1982 and June 2013 was 11 years . Patient survival has steadily improved since the 1980s, with one-year survival rates now exceeding 85 percent for patients transplanted in the most current era (2009 through June 2013). The major survival gains are limited to the first 6 to 12 months, with a long-term attrition rate of 3.4 percent per year thereafter, remaining largely unchanged. The improvement is probably larger than it appears, since the risk profile of recipients and the age of donors continue to increase.
Determinants of prognosis — A number of factors in the recipient and donor are associated with a worse prognosis post-transplantation.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- OUTCOME AFTER FIRST HEART TRANSPLANTATION
- Determinants of prognosis
- - Recipient factors
- - Donor factors
- - Patients undergoing mechanical circulatory support as a bridge to transplant
- - Late mortality
- Causes of death
- Repeat cardiac transplantation
- HEART-LUNG TRANSPLANTATION
- HEART-KIDNEY TRANSPLANTATION
- HEART-LIVER TRANSPLANTATION
- MEDICAL CONDITIONS AFTER CARDIAC TRANSPLANTATION THAT MAY AFFECT OUTCOME
- QUALITY OF LIFE AFTER TRANSPLANTATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS