Complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ifrah Fatima, M.B.B.S[2]
Overview
The prognosis of the patient depends on a number of donor and recipient factors. If left untreated, patients develop acute graft rejection. Common complications of cardiac transplant include acute graft rejection, graft failure, infections, Cardiac allograft vasculopathy (CAV), malignancies, and late graft rejection.
Complications and Causes of Death after Transplantation
The following table outlines the common causes of death in post-cardiac transplant patients [1]
| First 30 days post-transplant | From 1 month to 12 months post-transplant | After 5 years post-transplant |
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Prognosis
- Depending on the various factors of the donor and recipient at the time of transplant, the prognosis may vary.
- Prognosis is generally regarded as good. The 1-year survival is 84.5% and 5-year survival is 72.5%. [2]
- Post-transplant survival has improved over time.
- The median survival after adult heart transplants performed between 2002 and 2009 is 12.5 years, which extends to 14.8 years among 1-year survivors. [3]
The following are the factors determining prognosis-
Donor factors
Both the following factors are associated with an increased one-year mortality rate in the recipient.
Recipient factors
- Use of total artificial heart as a bridge to transplant or a need for end-organ support in the form of mechanical ventilation or dialysis- associated with the greatest one-year mortality
- Best prognosis is seen if the indication for transplant is ischemic and nonischemic cardiomyopathy [5]
- Patients with a history of congenital heart disease, restrictive cardiomyopathy, and those undergoing retransplantation have a worse prognosis.
- Younger recipients (below age 55) have an advantage
- Pre-transplant serum creatinine and total bilirubin are linearly related to survival.
Some other risk factors are:
- Use of Amiodarone pretransplantation [6]
- Hypertension
- Hypercholesterolemia [7] [8]
- Diabetes
- Renal insufficiency
- Use of specific immunosuppressive regimen
- Elevated body mass index
- Tobacco use
- Obesity
- Early post-transplant complications
- Prior cardiac surgery
- Transplantation of a female heart into a male or female recipient. [9]
References
- ↑ Montoya, Jose G.; Giraldo, Luis F.; Efron, Bradley; Stinson, Edward B.; Gamberg, Pat; Hunt, Sharon; Giannetti, Nadia; Miller, Joan; Remington, Jack S. (2001). "Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center". Clinical Infectious Diseases. 33 (5): 629–640. doi:10.1086/322733. ISSN 1058-4838.
- ↑ Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI; et al. (2014). "The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report--2014; focus theme: retransplantation". J Heart Lung Transplant. 33 (10): 996–1008. doi:10.1016/j.healun.2014.08.003. PMID 25242124.
- ↑ Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Hsich E; et al. (2019). "The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match". J Heart Lung Transplant. 38 (10): 1056–1066. doi:10.1016/j.healun.2019.08.004. PMC 6816343 Check
|pmc=value (help). PMID 31548031. - ↑ Potapov, Evgenij V.; Loebe, Matthias; H??bler, Michael; Musci, Michele; Hummel, Manfred; Weng, Yu-guo; Hetzer, Roland (1999). "MEDIUM-TERM RESULTS OF HEART TRANSPLANTATION USING DONORS OVER 63 YEARS OF AGE1". Transplantation. 68 (12): 1834–1838. doi:10.1097/00007890-199912270-00002. ISSN 0041-1337.
- ↑ Khush, Kiran K.; Cherikh, Wida S.; Chambers, Daniel C.; Goldfarb, Samuel; Hayes, Don; Kucheryavaya, Anna Y.; Levvey, Bronwyn J.; Meiser, Bruno; Rossano, Joseph W.; Stehlik, Josef (2018). "The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report—2018; Focus Theme: Multiorgan Transplantation". The Journal of Heart and Lung Transplantation. 37 (10): 1155–1168. doi:10.1016/j.healun.2018.07.022. ISSN 1053-2498.
- ↑ Cooper LB, Mentz RJ, Edwards LB, Wilk AR, Rogers JG, Patel CB; et al. (2017). "Amiodarone use in patients listed for heart transplant is associated with increased 1-year post-transplant mortality". J Heart Lung Transplant. 36 (2): 202–210. doi:10.1016/j.healun.2016.07.009. PMC 5241253. PMID 27520780.
- ↑ Singh TP, Almond CS, Semigran MJ, Piercey G, Gauvreau K (2012). "Risk prediction for early in-hospital mortality following heart transplantation in the United States". Circ Heart Fail. 5 (2): 259–66. doi:10.1161/CIRCHEARTFAILURE.111.965996. PMID 22308287.
- ↑ Radovancevic B, Poindexter S, Birovljev S, Velebit V, McAllister HA, Duncan JM; et al. (1990). "Risk factors for development of accelerated coronary artery disease in cardiac transplant recipients". Eur J Cardiothorac Surg. 4 (6): 309–12, discussion 313. doi:10.1016/1010-7940(90)90207-g. PMID 2361019.
- ↑ Prendergast TW, Furukawa S, Beyer AJ, Browne BJ, Eisen HJ, Jeevanandam V (1998). "The role of gender in heart transplantation". Ann Thorac Surg. 65 (1): 88–94. doi:10.1016/s0003-4975(97)01105-3. PMID 9456101.