Heart transplantation prognosis
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Risk calculators and risk factors for Heart transplantation prognosis |
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]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.
Prognosis
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 [2]
- 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
- Hypertension
- Hypercholesterolemia
- 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
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 world's longest-living heart transplant patient, Tony Huesman, survived for 28 years with a transplanted heart after having received a heart transplant in 1978. The surgery was performed at Stanford University by heart transplant pioneer Dr. Norman Shumway [4]
Comlications and Causes of Death after Transplantation
The following table outlines the common causes of death in post-cardiac transplant patients [5]
| First 30 days post-transplant | From 1 month to 12 months post-transplant | After 5 years post-transplant |
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References
- ↑ 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.
- ↑ 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. - ↑ Heart Transplant Patient OK After 28 Yrs (September 14, 2006) CBS News. Retrieved December 29, 2006.
- ↑ 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.