The Brazilian experience with heart transplantation: A multicenter report

Background: The results of heart transplantation in developing countries ar e influenced by the high incidence of marginal donors and the large number of recipients with characteristics of alternative list. The purpose of this multicenter report was to determine the rate of survival after heart trans plantation in a developing country. Also we studied the causes of death, th e results based on the year of transplant, the influence of gender and age, the numbers of transplants per year, and the etiology of the cardiomyopath y causing the heart failure. Methods: We studied 792 (632 male) patients who underwent orthotopic heart transplantation at 16 centers. The mean age of the patients was 42 +/- 16 y ears. Etiology included idiopathic dilated cardiomyopathy in 407 patients, ischemia in 196 patients, Chagas disease in 117 patients, and various other in 72 patients. Cyclosporine was the cornerstone of the immunosuppression administered. Results: Survival for the entire population at 3 months and 1, 4, 8, and 12 years was 72%, 66%, 54%, 40%, and 27%, respectively. There was an improvem ent in survival from 1991 to 1995 compared with before 1991. Age and gender did not influence the results. Unexpected early mortality was observed, bu t the late results were satisfactory. The most prevalent causes of death we re infection in 23%, acute graft failure in 19%, and rejection in 18%. Conclusions: Heart transplantation has become feasible in developing countr ies and the survival rate has improved without the influence of gender and age recipients. A chagasic etiology was found to be the third-leading indic ation for heart transplantation. The impact of increment of donors with app ropriate care for reduction of marginal donors, perhaps associated with bet ter recipient selection and postoperative care, should be investigated for improving early results.