Ten years experience with heart transplantation (1987-1997)

OBJECTIVES: Analyze ten years experience with heart transplantation at the Dijon University Hospital and determine which parameters control mid and lo ng term outcome. PATIENTS AND METHODS: One hundred thirty six heart transplantations were pe rformed over a 10 year period (1987-1997) in 118 men and 18 women aged 51-8 7 years. Heart transplantation was indicated on the basis of the following criteria. ejection fraction * 20%, pulmonary arteriole resistance <6 Wood u nits, peak oxygen uptake <14 l/kg/min. The Shumway or anatomic technique wa s used. The triple immunosuppressive protocol combined corticosteroids, aza thioprine and cyclosporin. The same team conducted the post-transplantation follow-up with regular programmed consultations in addition to those reque sted by the general practitioner, the cardiologist or the patient. Follow-u p was oriented according to the clinical situation (blood chemistry, cell c ounts, cyclosporinemia, search for infection, echocardiography, endomyocard ial biopsy, coronarography). RESULTS: Five patients (3.6%) died when still on the waiting list Absolute emergency transplantation was performed for patients (28.1%) including 8 (5 .9%) after circulatory assist Hospital mortality was 11.7% and late mortali ty was 16.1%. Actuarial survival was 78% at 1 year, 71% at 5 years and 69% at 10 years. Among the survivors, 94% were taking two, three or even lour d rugs for hypertension. Cyclosporin levels decreased and creatinine levels i ncreased. Episodes of rejection were minimal: 86.57% of the biopsies were * grade 1 and 4.45% * grade 2. Cytomegalovirus infection was documented and treated in 7.55% of the cases. Incidence of graft coronary artery disease w as 3.4% at 1 year, 6.5% at 2 years and 7.9% at 3 years. CONCLUSION: Our follow-up structure where the same small team conducts regu lar examinations together with our approach to heart transplantation appear s to be the main factor leading to the quality results obtained in this ser ies.