CARDIAC TRANSPLANTATION - THE STANFORD EXPERIENCE IN THE CYCLOSPORINEERA

We analyzed our experience with 496 patients who underwent primary car diac transplantation since the introduction of cyclosporine immunosupp ression (Dec. 16, 1980, to Jan. 7, 1993). There were 388 male and 108 female patients. Mean recipient age was 40 +/- 16 years (range 0.1 to 70 years, median 44 years). Recipient diagnoses included coronary dise ase in 188, idiopathic cardiomyopathy in 196, viral cardiomyopathy in 35, and congenital heart disease in 28 patients. Donor age was 25 +/- 10 years (range 1 to 53 years, median 24 years). Graft ischemic time w as 148 +/- 57 minutes (range 38 to 495 minutes, median 149 minutes). O perative mortality (hospital death) rate was 7.9% +/- 1.3% (70% confid ence intervals). Multivariate logistic regression analysis revealed th at (higher) pulmonary vascular resistance and gender (female) were the only independent predictors of hospital death (p < 0.05). Actuarial s urvival estimates for all patients at 1, 5, and 10 years are 82% +/- 1 .7% (83% +/- 1.8% adult, 77% +/- 5.2% pediatric), 61% +/- 2.5% (65% +/ - 2.5% adult, 64% +/- 6.6% pediatric), and 41% +/- 3.7% (40% +/- 4% ad ult, 54% +/- 8.6% pediatric), respectively. For 232 patients treated w ith triple-drug immunosuppression and induction with OKT3 since 1987, survival estimates at 1 and 5 years are 82% +/- 2.6% and 67% +/- 3.7%, respectively. Causes of death for the entire group were rejection in 29 (14% of deaths), infection in 69 (34%), graft coronary disease in 3 6 (18%), nonspecific graft failure in 6 (3%), malignancy in 19 (10%), stroke in 6 (3%), pulmonary hypertension in 6 (3%), and other causes i n 30 (15%) patients. Actuarial freedom from rejection at 3 months, 1 y ear, and 5 years was 21% +/- 1.9%, 14% +/- 1.7%, and 7.2% +/- 1.5%, re spectively (+/- 1 standard error of the mean). Estimates of freedom fr om rejection-related death at 1, 5, and 10 years were 96% +/- 1%, 93% +/- 1.4%, and 93% +/- 1.4%, respectively. Actuarial freedom from any i nfection at 3 months and at 1 and 5 years was 40% +/- 2.3%, 27% +/- 2. 1%, and 15% +/- 2.0% and from infection-related death, 95% +/- 1.0%, 9 3% +/- 1.2%, and 85% +/- 1.9%, respectively. Actuarial freedom from (a ngiographic or autopsy proved) graft coronary artery disease at 1, 5, and 10 years was 95% +/- 1.2%, 73% +/- 2.7%, and 65% +/- 3.6% and from coronary disease-related death or retransplantation 98% +/- 0.7%, 84% +/- 2.2%, and 66% +/- 4.3%, respectively, Multivariate (Cox model) pr oportional hazard, regression analysis revealed that (older) recipient age and race (nonwhite) were independent predictors of late (as oppos ed to hospital) death (p < 0.05). Immunosuppressive protocol was an in dependent predictor (p < 0.05) of freedom from rejection (but not from late death or from rejection-related death). These data demonstrate s atisfactory long-term results of cardiac transplantation for treatment of patients with end-stage heart disease.