Cardiac transplantation: An eight-year experience

Abstract

From June 1985 to June 1993, a total of 199 orthotopic (2 retransplanted) and one heterotopic cardiac transplants were performed in patients whose ages ranged from 17to 66(average 53)years. There were 175 (87.5%) males and 25 (12.5%) females. The aetiology of end-stage heart disease included: ischaemic heart disease 138 (69%); idiopathic cardiomyopathy 53 (26.5%); valvular disease 7 (3.5%); and adriamycininduced cardiomyopathy in 2 (1%). At the time of surgery, 56 (26.5%) patients were in United Network for Organ sharing (UNOS) Status I (ICU, intra-aortic balloon other assists, inotropic support) and 144 (72%) were UNOS Status II. The majority of donors were local or within the state. Two immunosuppressive protocols have been utilised, viz., conventional triple drug therapy and OKT3 induction. The mean rejection has been 2.5 episodes/patient. The majority of these episodes, (72 %) occurred within the first three months. Of the 1.8 infectious episodes per patient, opportunistic organisms predominated with a 98 per cent recovery. We have experienced 53 postoperative deaths. Currently, 147 (73.5%) recipients are alive and well. Our one-year actuarial survival is approximately 82per cent, the five year figure being 64 per cent. Tampa General Hospital is, at present, one of the most active cardiac transplant centres in the USA. Our eightyear experience has allowed us to mature through our learning curve to become an established, successful cardiac transplant program.