Thirty years of cardiac transplantation at Stanford University

Background: The experience with 30 years of cardiac transplantation at Stan ford University Medical Center was reviewed. A total of 954 transplants wer e performed in 885 patients. Patients were divided into 3 groups based on i mmunosuppression received: group I, no cyclosporine (INN: ciclosporin) (n = 201) (January 1968-November 1980); group II, cyclosporine (n = 248) (Decem ber 1980-June 1987); and group III, cyclosporine + OKT3 (n = 436) (July 198 7-March 1998). Results: The 1-, 5-, and 10-year actuarial survivals were 68 %, 41%, and 24% (group I); 80%, 57%, and 37% (group II); and 85%, 68%, and 46% (group III) (I vs II, P <.01; I vs III, P <.005; and II vs III, P <.005 ). The 1-, 5-, and 10-year actuarial death rates from rejection were 8%, 12 %, and 14% (group I); 5%, 7%, and 7% (group II); and 2%, 5%, and 5% (group III) (I vs II, P = not significant; I vs III, P <.005; and II vs III, P <.0 05). The 1-, 5-, and 10-year actuarial death rates from infection were 25%, 43%, and 50% (group I); 8%, 17%, and 29% (group II); and 6%, 11%, and 16% (group III) (I vs II, P <.005; I vs III, P <.005; and II vs LII, P <.05). T he 1-, 5-, and 10-year actuarial death rates from graft coronary artery dis ease were 0%, 5%, and 13% (group I); 0%, 12%, and 19% (group II); and 1%, 6 %, and 9% (group In) (I vs II, P <.01; I vs III, P <.005; and II vs III, P = not significant). There have been 69 retransplants in 67 patients with 1- , 5-, and 10-year actuarial survivals of 49%, 27%, and 15%, respectively. C onclusions: The evolution of 3 decades of experience with cardiac transplan tation has resulted in improved overall survival. The incidence of rejectio n and of death from infection and graft coronary artery disease have decrea sed over time, primarily as a result of improvements in immunosuppression a nd in the prevention and treatment of infection. Continued advances in peri operative management and the development of more specific, less toxic immun osuppressive agents could further refine this initial experience and improv e the survival and quality of life of patients after cardiac transplantatio n.