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Prognosis after cardiac transplantation

Michael X Pham, MD, MPH
Section Editor
Sharon A Hunt, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


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".)


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 [3]. 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.

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Literature review current through: Nov 2017. | This topic last updated: Jan 27, 2016.
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