Intensive care medicine

Heart transplantation

Renal transplant

Cohort

Surgery

Single Center

Transplantation

Endocrinology

Environmental health

Heart failure

Physics

Retrospective cohort study

Optics

Medical record

Population

Internal medicine

Medicine

Incidence (geometry)

Diabetes mellitus

Purpose: To assess clinical outcomes and current medical complications in a cohort of patients ten years after cardiac transplantation from a single center. Heart transplantation remains the gold standard for therapy for patients with end stage heart failure who have failed all other medical therapies. Information regarding longer term adverse events beyond ten years after transplant is limited. We reviewed our patient population who survived 10 years post transplant. Methods: We performed a retrospective review of all patients transplanted at a single center university transplant program between 1993-2003. All pertinent patient data collected at the period ten years after transplant were reviewed, including incidence of diabetes, cardiac allograft vaculopathy, the development of post-transplant heart failure, post transplant rejection, and rates of infection over the course of 10 years of graft survival. Results: A total of 114 patients were transplanted in that period. 31 patients died or were lost to follow up within the ten year period examined. 83 patients were successfully followed for at least ten years. At the decade mark, 15.8 % of patients had developed diabetes, 17.5% of patients had I cardiac allograft vasculopathy defined angiographically by the ISHLT Nomenclature, 7.9% of patients were diagnosed with heart failure and/or had worsening of graft function, 21% of patients developed chronic kidney disease, 43% of patients developed at least one infection (defined as reactivation/activation of CMV, opportunistic infections or sepsis, all requiring treatment), and 18% had at least one episode of ISHLT Grade 2R or greater acute cellular rejection. Conclusion: Overall, the ten year survivors were doing well but were confronted with increasing chronic health issues such as diabetes, renal disease and cardiac allograft vasculopathy. Reactivation of CMV, and opportunistic infections were also problems. Clinical outcome data for cardiac transplant patients who survive beyond ten years after transplant is limited and warrants further study to address health concerns and considerations in the aging transplant patient.

Clinical Outcomes of Cardiac Transplant Recipients Ten Years After Transplant.