Factors affecting long-term survival (> 10 years) after cardiac transplantation in the cyclosporine era

OBJECTIVES The aim of this study was to determine long-term survival (>10 y ears) after cardiac transplantation in the cyclosporine era and identify ri sk factors influencing long-term survival. BACKGROUND Despite the availability of newer modalities for heart failure, cardiac transplantation remains the treatment of choice for end-stage heart disease. METHODS Between 1983 and 1988, 195 patients underwent heart transplantation at a single center for the treatment of end-stage heart disease. Multivari able logistic regression analysis of pretransplant risk factors affecting l ong-term survival after cardiac transplantation included various recipient and donor demographic, immunologic and peritransplant variables. RESULTS Among the group of 195 cardiac transplant recipients, actuarial sur vival was 72%, 58% and 39% at 1, 5 and 10 years respectively. In the 65 pat ients who survived >10 years, mean cardiac index was 2.9 1/m(2) and mean ej ection fraction was 58%. Transplant-related coronary artery disease (TRCAD) was detected in only 14 of the 65 patients (22%). By multivariable analysi s, the only risk factor found to adversely affect long-term survival was a pretransplant diagnosis of ischemic cardiomyopathy (p = 0.04). CONCLUSIONS Long-term survivors maintain normal hemodynamic function of the ir allografts with a low prevalence of TRCAD. It is possible that similar r isk factors that lead to coronary artery disease in native vessels continue to operate in the post-transplant period, thereby contributing to adverse outcomes after cardiac transplantation. Aggressive preventive and therapeut ic measures are essential to limit the risk factors for development of coro nary atherosclerosis and enable long-term survival after cardiac transplant ation. (J Am Cell Cardiol 2001;37:189-94) (C) 2001 by the American College of Cardiology.