RESULTS OF HEART-TRANSPLANTATION BY EXTENDING RECIPIENT SELECTION CRITERIA

From November 1985 to July 1993, 29 out of 241 patients (12%) who unde rwent heart transplantation (HTx) at our institution had one or more ' 'classical'' contraindications to HTx: age greater than or equal to 60 years (20 patients); insulin-dependent diabetes mellitus (5 patients) ; irreversible renal failure requiring combined heart-kidney transplan tation (2 patients); previous Surgery for malignancy (1 patient); fami lial hypercholesterolemia (1 patient) and active systemic infection (1 patient). The main indication for HTx was ischemic cardiomyopathy (21 patients, 61%). Immunosuppression regimen consisted of Cyclosporine a nd Azathioprine, oral prednisone being subsequently added in 6 patient s because of persistent rejection, There were 2 perioperative deaths a nd one late death. Follow-up ranged from 1 to 88 months (mean, 28 +/- 20) with an actuarial survival at 5 years of 85 +/- 8%. Annual cardiac catheterization demonstrated normal graft function and coronary arter ies in all. No significant differences in survival, incidence of rejec tion and infection, renal function and duration of hospitalization wer e found when these patients were compared with those with no contraind ications to HTx. In conclusion, HTx can be performed with good early c linical results in selected patients with ''classical'' contraindicati ons to HTx; longer follow-up, however, is needed to confirm whether ex tension of the recipient selection criteria justified.