CHARACTERISTICS OF PATIENTS SURVIVING MORE THAN 10 YEARS AFTER CARDIAC TRANSPLANTATION

The clinical status and quality of life of 40 patients who lived or ar e still alive more than 10 years after transplantation at our institut ion were reviewed with the use of our transplant database, prospective patient examinations, cardiac catheterization, and exercise testing. Patient-perceived health status was determined with use of the Notting ham Health Profile and General Well Being examinations. Factors associ ated with longevity were determined by a Cox proportional hazards mode l. Twenty-six patients are alive and 14 have died. The mean age at tra nsplant was 32.4 +/- 12 years and the current age (or age at death) is 46.1 +/- 12.8 years. Actuarial freedom from rejection was similar to that of patients surviving less than 10 years (p = 0.8), but freedom f rom all types of infection was less (p = 0.005). Immunosuppressive dru gs include cyclosporine (11/26 patients), azathioprine (24/26), and pr ednisone (26/26, mean dose 12.7 mg/day). Catheterization hemodynamic d ata show well-preserved graft function at a mean follow-up of 11.7 +/- 3.3 years. Graft coronary artery disease prevalence is 51.0% +/- 8%. Exercise test results are as follows: duration 8.7 +/- 3.5 minutes (ra nge 2 to 16 minutes), maximum heart rate/expected rate 77.3% +/- 11% ( 50% to 92%), maximum systolic blood pressure 171 +/- 23 mm Hg (140 to 208 mm Hg), and metabolic equivalents 9.2 +/- 2.3 units (5.5 to 12.9 u nits), or about 84% of predicted. Mean score on the General Well Being examination was 75.3 +/- 21.6 (normal). Nottingham Health Profile sco res were nearly normal, except for in the 50- to 64-year-old age group in categories of mobility, pain, sleep quality, and energy level. Cau ses of death were coronary artery disease in 7 of 14, infection in 4 o f 14, lymphoma in 1 of 14, and nonlymphoid cancer in 2 of 14. In the C ox regression, variables most associated with survival (t > 2.0, multi variate p = 0.0005) were age at transplantation (t = 3.26), preoperati ve duration of illness (t = 3.57), postoperative cytomegalovirus infec tion (t = 2.16), and ejection fraction at 12 months after operation (t = -2.62). We conclude that cardiac transplantation can provide patien ts with end-stage cardiac failure an acceptable general medical condit ion, functional status, and perceived quality of life well into the se cond decade after operation.