Thoracic transplantationSurvival Beyond 10 Years Following Heart Transplantation: The Cleveland Clinic Foundation Experience
Section snippets
Patient Population
Between August 1, 1984 and May 31, 2004, a total of 1089 adult patients underwent HTx at the Cleveland Clinic Foundation. To study patients who survived beyond 10 years, we evaluated a consecutive cohort of 325 patients who underwent transplantation between August 1, 1984 and May 31, 1994. A total of 170 patients survived more than 10 years. We excluded 11 patients who underwent retransplantation during the first 10-year period.
Data Collection
Our data was retrieved from the Cleveland Clinic Foundation Heart
Survival Analysis
Kaplan-Meier survival plot of all 325 adult patients who underwent HTx between August 1984 and May 1994 is shown in Fig 1. The 10-year and 15-year Kaplan-Meier survival rates were 54% and 41%, respectively. A total of 170 patients survived beyond 10 years after cardiac transplantation and constitute the cohort of the study. Among the cohort of 170 patients, 3 patients comprise the oldest living transplant recipients at the age of 80 years and 1 patient constitutes the longest living patient who
Discussion
This study shows that the 10-year and 15-year survival rates of all patients who underwent transplantation between August 1984 and May 1994 at our institution were 54% and 41%, respectively. Based on the Organ Procurement and Transplant Network database, the reported 10-year and 15-year nationwide survival rates are 48% and 30%, respectively.
Although long-term survival is associated with high quality of life in the majority of the patients, HTx has a high complication rate in long-term
Conclusion
Long-term survival following HTx is not uncommon, although it is associated with a high incidence of chronic complications, including hypertension, hyperlipidemia, diabetes mellitus, ESRD, GCAD, and malignancy. Beyond 10 years, malignancy is a major cause of death.
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Incidence of temporary mechanical circulatory support before heart transplantation and impact on post-transplant outcomes
2018, Journal of Heart and Lung TransplantationContinuous improvement in outcome after heart transplantation — Long-term follow-up after three decades of experience
2017, International Journal of CardiologyCitation Excerpt :The survival after HTx in our institution is well in line with the best results published, with very similar survival to those reported from Nantes in France (75%, 58% and 42% survival after 5, 10 and 15 years, respectively) [6] and also well in line with results previously reported from Scandinavia [2]. Moreover, our survival is in concordance with what has been reported from Cleveland Clinic, USA (54% and 42% survival at 10 and 15 years, respectively) [7]. Our results compare favourable to the ISHLT registry, reporting 10-year survival of 40–50% and a median survival below 11 years for the last cohort [8].
Surviving 20 years after heart transplantation: A success story
2014, Annals of Thoracic SurgeryMalignancies after heart transplantation: Incidence, risk factors, and effects of calcineurin inhibitor withdrawal
2010, Transplantation ProceedingsCitation Excerpt :In fact, these practices explain the higher prevalence of PTLDs in cardiac transplant recipients compared with renal transplant recipients (6.5% vs 0.7%).19 In this study, overall incidence of lymphomas was low (3.3% of all transplant recipients), which might be attributed to the generally low level of immunosuppression and T-cell monitoring during administration of RATG as induction therapy in order to minimize drug exposure.2 Earlier reports have linked the use of a CNI to the development of PTLD.15
Natural course and risk factors for impaired renal function during the first year after heart transplantation
2010, Journal of Heart and Lung TransplantationOutcome of Heart Transplants 15 to 20 Years Ago: Graft Survival, Post-transplant Morbidity, and Risk Factors for Mortality
2008, Journal of Heart and Lung TransplantationCitation Excerpt :However, HTx remains the therapy of choice for end-stage cardiopathies, as demonstrated by this study with long-term survivals unequalled by other treatments. Indeed, the follow-up reached by several international transplantation centers allows them to publish very satisfactory survival rates at 10 years,5–7 but few teams have assessed their patients' survival for longer than 15 years of follow-up. The ISHLT registry estimates that about 30% of HTx patients are still alive at this stage of transplantation, whereas in our series we report a survival rate of 42% at 15 years.