Late complications of heart transplantation: as 11-year experience

Advances in donor and recipient selection and postoperative management of p atients undergoing a heart transplant have improved survival after cardiac transplantation; nevertheless, late complications are still the main cause of mortality. Between January 1988 and March 1999, 200 heart transplants an d 2 retransplants were performed at our Institution. The actuarial survival rate was 84.45% at 1 month, 75.22% at 1 year, and 69.48% at 5 years. One-h undred forty-five patients reached at least 6 months of follow-up. In this group of patients we reviewed all available pathological specimens from end omyocardial biopsies, autopsies, and hearts retrieved at retransplantation. The most frequent late complications have been: malignancies (9 patients), allograft coronary artery disease (ACAD) (6 patients), and infections (6 p atients). All patients with ACAD had serological evidence of cytomegaloviru s (CMV) infection and 5 of them (83.3%) of hepatitis C virus (HCV) infectio n. Squamous cell lung carcinoma and Kaposi's sarcoma were the most frequent neoplasms (3 patients). Twenty-sis out of 145 patients died during the fol lowup: sudden death occurred in 10 patients (38.46%), infections caused dea th in 6 patients (23.08%), ACAD in 4, and cancer in 4. Causes and rates of late mortality in patients with a cardiac transplant differ from those of e arly mortality. Development of infections, ACAD, or cancer is associated wi th a high late mortality rate. A striking correlation has been found betwee n ACAD and HCV and/or CMV positivity, suggesting that such viruses may Flay a role in the development of vascular late complications in transplanted h earts.