Twenty Years Survivors after Heart Transplantation: La Pitié Experience

Abstract

Purpose To evaluate patients surviving >20 years after orthotopic heart transplantation (OHT). Methods and Materials Medical records of all OHT recipients surviving >20 years were reviewed retrospectively. Patients undergoing heterotopic, multiorgan or re-transplantation were excluded. Results From 1981 to 1992, 758 OHTs were performed at our institution. Among these, 115 (15%) patients survived >20 years with a single graft. Eighty-three (72%) were males and mean age at transplant was 41±13 years. Causes for heart failure were dilated cardiomyopathy in 63 (55%) and ischemic heart disease in 32 (28%), patients. Thirty-six (31%) patients died during follow-up. Actuarial survival was 72±5%, 62±6% and 50±7% at 23, 25 and 27 years, respectively. Allograft rejection grade ≥2R was noted in 42 (36%) patients. Rejection-free survival was 63±5% at 20 and 25 years. Cardiac allograft vasculopathy (CAV) grade 2-3 was diagnosed in 29 (35%) patients. CAV-free survival was 79±4% and 74±5% at 20 and 25 years, respectively. Malignancies were diagnosed in 61 (53%) and were multiple in 25 (22%) patients. Most common type was skin malignancy (57%), followed by non-lymphoid (44%) and lymphoid (26%) malignancies. Malignancy-free survival was 55±5% and 43±5% at 20 and 25 years, respectively. At latest follow-up, 106 (92%) survivors had hypertension and 23 (20%) diabetes. Forty (35%) patients had renal dysfunction, 18 (16%) received hemodialysis and 8(7%) had undergone renal transplantation. Echocardiography performed 23±3 years after OHT showed LV ejection fraction of 62±12%, LV end-systolic and end-diastolic diameters of 30±5mm and 50±6mm, respectively. Tricuspid regurgitation (grade ≥2) was found in 7 (9%) survivors. Quality of life (SF-36 health survey) showed mean physical and mental scores of 56±26 and 56±22, respectively. Conclusions Fifteen percent of early OHT recipients survived more than 20 years and showed excellent LV performance and good quality of life. CAV and malignancies account for significant late morbidity and mortality.