Elsevier

Transplantation Proceedings

Volume 41, Issue 10, December 2009, Pages 4289-4293
Transplantation Proceedings

Thoracic transplantation
Heart Transplantation in a Low-Organ-Donation Environment: A Single Center Experience

https://doi.org/10.1016/j.transproceed.2009.09.079Get rights and content

Abstract

Objective

Heart transplantation is the “gold standard” for treating patients in end-stage heart failure who satisfy strict selection criteria. However, infrequent transplant performance, eg, less than nine per year, may be associated with suboptimal results.

Methods

We reviewed our 13-year clinical experience (1996–2008) with 73 orthotopic heart transplants performed under strict selection criteria and followed closely thereafter at the only accredited center in Greece, a country with an annual rate of only seven donors per million population.

Results

Low perioperative (5.47%) and long-term (7.5%) mortality rates were responsible for a 94% survival rate in the first year, 92% at five years, and 70% at ten years—similar to those reported worldwide—along with excellent functional recovery.

Conclusion

Strict recipient and donor selection criteria, combined with a rigorous multidisciplinary follow-up, yield excellent results despite the existing shortage of available grafts.

Section snippets

Patient Selection

Absolute requirements for placement on the transplant waiting list were the exhaustion of all conventional medical and surgical therapies4 and the documentation of a low functional class5 (American College of Cardiology/American Heart Association [ACC/AHA] stages C and D previously New York Heart Association classes III and IV), along with poor life expectancy according to internationally accepted criteria.6 In recent years, the use of ventricular assist devices (VAD) has altered the transplant

Results

As expected, a number of candidates (n = 36) died before a suitable graft could be obtained (on-list mortality 33.6%), after waiting for 123.3 ± 252.8 days (range 3–1,387 days). However, the mortality on the waiting list was not the same at the beginning of the program (1996–2003) compared with that in recent years (2004–2008), the reason being the introduction of VADs as a “bridge” to transplantation in 2003. The waiting time to transplantation or death in 55 patients who entered the list

Discussion

This paper has described our experience with 73 patients receiving a heart transplant for end-stage cardiac failure over a 13 year period, ie with an average output of 5.6 transplants per year, which is well below the recommended activity.2 However, the survival rates of 94% in the first year, 92% at 5 years, and 70% at 10 years were similar to those provided by the ISHLT3 (Fig 1). The 65 transplant survivors are free of symptoms and enjoy a good quality of life. These results compared

References (50)

  • C.C. Canver et al.

    Milrinone is for long-term pharmacologic support of the status 1 heart transplant candidates

    Ann Thorac Surg

    (2000)
  • P.J. Hendry et al.

    A comparison of intracellular solutions for donor heart preservation

    J Thorac Cardiovasc Surg

    (1993)
  • S.A. Lubitz et al.

    Improved survival with statins, angiotensin receptor blockers, and steroid weaning after heart transplantation

    Transplant Proc

    (2006)
  • J. Cremer et al.

    Progression of steroid-associated osteoporosis after heart transplantation

    Ann Thorac Surg

    (1999)
  • El Kapetanakis et al.

    Effect of long-term calcitonin administration on steroid-induced osteoporosis after cardiac transplantation

    J Heart Lung Transplant

    (2005)
  • P.K. Caves et al.

    Diagnosis of human cardiac allograft rejection by serial cardiac biopsy

    J Thorac Cardiovasc Surg

    (1973)
  • R.B. Griepp et al.

    Acute rejection of allografted human heart

    Ann Thorac Surg

    (1971)
  • D.R. Onsager et al.

    Efficacy of tacrolimus in the treatment of refractory rejection in heart and lung transplant recipients

    J Heart Lung Transplant

    (1999)
  • J.K. Kirklin et al.

    Current outcomes following heart transplantation

    Semin Thorac Cardiovasc Surg

    (2004)
  • P.P. Chang et al.

    Mild vs severe pulmonary hypertension before heart transplantation: different effects on posttransplantation pulmonary hypertension and mortality

    J Heart Lung Transplant

    (2005)
  • S. Goland et al.

    Pre-existing pulmonary hypertension in patients with end- stage heart failure: impact on clinical outcome and hemodynamic follow-up after orthotopic heart transplantation

    J Heart Lung Transplant

    (2007)
  • D. Zimpfer et al.

    Left ventricular assist devices decrease fixed pulmonary hypertension in cardiac transplant candidates

    J Thorac Cardiovasc Surg

    (2007)
  • M.J. Russo et al.

    The effect of ischemic time on survival after heart transplantation varies by donor age: an analysis of the United Network for Organ Sharing database

    J Thorac Cardiovasc Surg

    (2007)
  • O. Grauhan

    Criteria for the assessment of the donor heart

    Transplant Proc

    (2003)
  • N. Khasati et al.

    Donor heart selection: Wythenshawe experience

    Transplant Proc

    (2005)

    • Cited by (2)

    The transplant team thanks the “Alexander S. Onassis” Charitable Foundation for supplying the program's infrastructure and for the staff training abroad.

    View full text
    Copyright © 2009 Elsevier Inc. All rights reserved.