DETERMINANTS OF HOSPITAL SURVIVAL AFTER CARDIAC TRANSPLANTATION

To identify the preoperative factors that influence hospital survival after transplantation we analyzed our consecutive experience of 183 tr ansplantations in 179 patients over a 10-year period. There were 151 m ale and 29 female transplant recipients ranging in age from 10 days to 70 years (mean, 48 +/- 1 years). Diagnoses included coronary disease in 110 patients, cardiomyopathy in 55 patients, valvular disease in 6 patients, and congenital heart disease in 9 patients. Seventy-seven ha d undergone a previous cardiac operation, and 30 patients required pre operative mechanical support. Forty patients received hearts from dono rs who were 40 years old or older (range, 40 to 62 years). Ischemic ti me was greater than 240 minutes in 32 cases, and pulmonary vascular re sistance was greater than 3 Wood units in 40 patients (range, 3.1 to 1 0.0 Wood units). Cyclosporine induction was used in 52 patients, where as 128 recipients received polyclonal antibody prophylaxis. There were 25 hospital deaths. Recipient diagnosis, use of mechanical support, d onor age, and the immune suppression protocol were related to hospital survival according to univariate analysis. Using multiple logistic re gression, only the method of immune suppression induction and the use of mechanical assists were significant independent determinants of sur vival. In conclusion, we believe that extended ischemic times and dono r age do not adversely affect the early success of transplantation, wh ereas induction with immune globulin may reduce early mortality. Patie nts requiring mechanical support before transplantation continue to be a challenge.