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J Thorac Cardiovasc Surg 1995;109:1103-1115
© 1995 Mosby, Inc.
CARDIAC AND PULMONARY REPLACEMENT |
Stanford, Calif.
From the Department of Cardiothoracic Surgery, Stanford UniversityMedical Center, Stanford, Calif.
Address for reprints: William M. DeCampli, MD, PhD, Division of CardiothoracicSurgery, Children's Hospital Oakland, 747-52nd St., Oakland, CA 94609.
Abstract
The clinical status and quality of life of 40 patientswho lived or are still alive more than 10 years after transplantation at ourinstitution were reviewed with the use of our transplant database, prospectivepatient examinations, cardiac catheterization, and exercise testing. Patient-perceivedhealth status was determined with use of the Nottingham Health Profile andGeneral Well Being examinations. Factors associated with longevity were determinedby a Cox proportional hazards model. Twenty-six patients are alive and 14have died. The mean age at transplant was 32.4 ± 12 years and the currentage (or age at death) is 46.1 ± 12.8 years. Actuarial freedom fromrejection was similar to that of patients surviving less than 10 years (p = 0.8), but freedom from alltypes of infection was less (p = 0.005). Immunosuppressive drugsinclude cyclosporine (11/26 patients), azathioprine (24/26), and prednisone(26/26, mean dose 12.7 mg/day). Catheterization hemodynamic data show well-preservedgraft function at a mean follow-up of 11.7 ± 3.3 years. Graft coronaryartery disease prevalence is 51.0% ± 8%. Exercise test results areas follows: duration 8.7 ± 3.5 minutes (range 2 to 16 minutes), maximumheart rate/expected rate 77.3% ± 11% (50% to 92%), maximum systolicblood pressure 171 ± 23 mm Hg (140 to 208 mm Hg), and metabolic equivalents9.2 ± 2.3 units (5.5 to 12.9 units), or about 84% of predicted. Meanscore on the General Well Being examination was 75.3 ± 21.6 (normal).Nottingham Health Profile scores were nearly normal, except for in the 50-to 64-year-old age group in categories of mobility, pain, sleep quality, andenergy level. Causes of death were coronary artery disease in 7 of 14, infectionin 4 of 14, lymphoma in 1 of 14, and nonlymphoid cancer in 2 of 14. In theCox regression, variables most associated with survival t > 2.0, multivariate p = 0.0005) were age at transplantation(t = 3.26), preoperative duration of illness(t = 3.57),postoperative cytomegalovirus infection (t = 2.16), and ejection fraction at 12 monthsafter operation (t = -2.62). We conclude that cardiac transplantationcan provide patients with end-stage cardiac failure an acceptable generalmedical condition, functional status, and perceived quality of life well intothe second decade after operation. (J T HORAC C ARDIOVASC S URG 1995;109:1103-15)
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