HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Peter S. Greene Duke E. Cameron Timothy J. Gardner Bruce A. Reitz William A. Baumgartner Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Greene, P. S. Articles by Baumgartner, W. A. Search for Related Content PubMed PubMed Citation Articles by Greene, P. S. Articles by Baumgartner, W. A.

Ann Thorac Surg 1989;47:650-654
© 1989 The Society of Thoracic Surgeons

---

Articles

Exploratory analysis of time-dependent risk for infection, rejection, and death after cardiac transplantation

The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

^_* Address reprint requests to Dr Baumgartner, Department of Surgery, Blalock 618, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore MD 21205.

Data from 95 heart transplantations performed at The Johns Hopkins Hospital from July 1983 to October 1988 were analyzed to detect patterns of morbidity and mortality. Using nonparametric techniques, hazard functions were determined for all deaths and for deaths due to infection or rejection. The rates of rejection and infection (episodes per patient-month) were determined within each of ten intervals following transplantation. A total of 19 deaths, 281 rejection episodes, and 180 distinct infections were available for analysis during a follow-up of 1 to 62 months. The hazard function for rejection appeared biphasic, with a rapidly decelerating early phase during the first year followed by a constant late phase. The hazard function for infection was triphasic, with a delayed, decelerating early phase, a period of increased risk approximately 2 years after operation, and finally a late constant phase. Both infection and rejection rates (episodes per patient-month) were biphasic, with rapidly decelerating early phases and constant late phases. Multiple regression analysis demonstrated that eventually nonsurviving patients had significantly higher rates of rejection and infection during both the early and late phases compared with survivors. The increased rate of rejection among nonsurvivors was evident throughout follow-up, although no deaths were attributable directly to rejection after the first 8 months. These data suggest that a complex interrelationship between infection and rejection determines late survival after cardiac transplantation and that aggressive treatment of late rejection predisposes toward death from infection.

This article has been cited by other articles:

				K. V. Arom and F. L. Grover Adult cardiac surgery during the first 50 years of the Southern Thoracic Surgical Association Ann. Thorac. Surg., November 1, 2003; 76(90050): S17 - 46. [Abstract] [Full Text] [PDF]

				K. Bando, I. L. Paradis, K. Komatsu, H. Konishi, M. Matsushima, R. J. Keenan, R. L. Hardesty, J. M. Armitage, and B. P. Griffith Analysis of time-dependent risks for infection, rejection, and death after pulmonary transplantation J. Thorac. Cardiovasc. Surg., January 1, 1995; 109(1): 49 - 59. [Abstract] [Full Text]

				G. B. Luciani, G. Faggian, R. Razzolini, U. Livi, U. Bortolotti, and A. Mazzucco Severe ischemic left ventricular failure: Coronary operation or heart transplantation? Ann. Thorac. Surg., March 1, 1993; 55(3): 719 - 723. [Abstract] [PDF]

				M. Carrier, J. Wild, L. C. Pelletier, and J. G. Copeland Bromocriptine as an adjuvant to cyclosporine immunosuppression after heart transplantation Ann. Thorac. Surg., January 1, 1990; 49(1): 129 - 132. [Abstract] [PDF]