The Annals of Thoracic Surgery, Vol 43, 585-590, Copyright © 1987 by The Society of Thoracic Surgeons
Present expectations in cardiac transplantation
WA Baumgartner, S Augustine, AM Borkon, TJ Gardner and BA Reitz
The clinical introduction of cyclosporine has resulted in increased
enthusiasm for cardiac transplantation. Since July, 1983, 61 patients (50
male and 11 female) have undergone orthotopic cardiac transplantation for
cardiomyopathy (48 patients), ischemic heart disease (11), or congenital
heart disease (2). Mean age was 39 years (range, 1.5 to 57 years). Median
hospital stay was 26 days (range, 4 to 60 days). Maintenance
immunosuppression consisted primarily of prednisone and cyclosporine; it
was modified in 9 patients because of a pre-existing clinical condition.
The incidence of rejection was 0.44 episode/patient-month within 3 months
of cardiac transplantation and 0.10 episode/patient-month subsequently. The
incidence of infection was 0.05 episode/patient-month. Major side effects
of cyclosporine included renal dysfunction (63%) and hypertension (61%). No
recipient required dialysis for renal dysfunction. Ten patients died
(rejection, 4; infection, 3; carcinoma, 1; lymphoma, 1; and pulmonary
hemorrhage, 1); actuarial survival at 1 and 2 years was 84 +/- 6% and 76
+/- 8%, respectively. Patient follow-up (cumulative, 719 patient-months)
revealed that 96% of recipients were rehabilitated and 50% had returned to
work. With increasing understanding of cyclosporine immunosuppression,
recipients can continue to look forward to an extended life with nearly
complete rehabilitation.
