SAN FRANCISCO — Better treatments for posttransplant hypertension or cardiac allograft vasculopathy would help more patients reach 20 years of survival after a heart transplant, Dr. Saleem Haj-Yahia said at the annual meeting of the International Society for Heart and Lung Transplantation.
Little is known about clinical factors associated with long-term survival after a heart transplant. To elucidate such factors, Dr. Haj-Yahia and his associates at Royal Brompton and Harefield Hospital, London, analyzed data on 211 patients who underwent orthotopic heart transplantation between 1980 and 1985. Detailed records also were available for 107 donors in these cases.
Twenty years after their transplants, 53 of the 211 patients (25%) were still alive.
Actuarial survival rates for other times after transplant were 71% at 1 year, 61% at 5 years, 47% at 10 years, and 34% at 15 years. By 25 years posttransplant, 16% of patients remained alive.
Twenty-year survival was more likely in patients who were younger at the time of the transplant, did not develop posttransplant hypertension, and had later development of cardiac allograft vasculopathy (CAV) than did other patients, he reported.
Multivariate analysis showed that older age at transplant nearly doubled the risk of death before 20 years, and the development of posttransplant hypertension increased the risk of death more than fivefold.
A longer interval from transplant to the diagnosis of angiographic CAV increased the odds of long-term survival by about 27%, Dr. Haj-Yahia reported.
“That means more effective treatment of posttransplant hypertension and CAV may improve survival,” he said.
Factors not associated with long-term survival included the gender of the recipient or donor, the donor's age, ischemic time, the indication for transplantation, posttransplant diabetes, renal impairment, human leukocyte antigen levels, recent left ventricular function, frequency of rejection in the first year post transplant, and immunosuppressive regimen.
Cardiac-related events were the main cause of death in this cohort.