The program of heart transplantation at IKEM from 31 January 1984 through 31 May 2005

Abstract

Introduction: Orthotopic heart transplantation (OHT) is currently considered standard treatment of patients with end-stage heart failure. The program of OHT in the Czech Republic was launched at the Institute for Clinical and Experimental Medicine (IKEM) on 31 January 1984 and, in October 2005, the first transplant recipient marked 21 years since his successful surgery. This presentation is an analysis of the benefits and limitations of the program of OHT at IKEM. Methods: Our group of patients includes 572 (480 males and 92 females) patients undergoing OHT; four males had repeat transplantation. The mean age of our patients was 47.5 years (± 11.3). The PATS clinical expert system was used for data storing and analysis (Dentrite Inc., Portland, OR). Data are processed using descriptive statistics, with cumulative survival calculated by Kaplan-Meier method. Results: When evaluating one-year survival rates of patients at IKEM since 1990, i. e., after five years of experience with OHT, the one-, 10- and 15-year survival rates among the 527 transplant recipients were 80.5%, 50.9%, and 29%, respectively. The underlying disease leading to end-stage heart failure was dilated cardiomyopathy in 49.3% and coronary heart failure in 39.6%, with other diagnoses making up 10%. The fate of patients after OHT is affected by a variety of risk factors. In our series, longer survival times were documented in patients with the diagnosis of dilated cardiomyopathy; females, and, among males, those receiving grafts from donors of the same gender. Better survival times were also seen in patients with cardiac grafts from donors below 45 years of age. The main problem we are faced with is the paucity of donor grafts, a major limitation to the number of OHT. The most frequent cause of death of transplant recipients was cardiac graft failure, occurring in 76 patients (33% of all deaths). Conclusion: Our results are consistent with data published in the latest (i. e., XXIst) Annual Report of the International Society for Heart and Lung Transplantation (ISHLT). Although no randomized studies have been conducted, it is generally accepted that heart transplantation undertaken after all other therapeutic options have been exhausted prolongs life and improves its quality.