[Results of heart transplantation: experience of 233 grafts].

Background: Heart failure is one of the leading causes of hospitalization and death. The aim of this study was to evaluate long term outcomes after cardiac transplantation.

Methods: A retrospective review of 222 consecutive cardiac allograft recipients who underwent 233 transplantations between 1986 to 2000 was undertaken. Cardiomyopathy (123) and ischemic heart disease (87) were the most common indications. Mean age was 51 years +/- 11, and male gender was predominant (184).

Results: 33 patients (14.8%) died in the post operative period, mainly from graft failure (24 pts). During the follow-up period (total 1157 pt/yrs, mean 6.2 +/- 5 yrs, max 16 yrs), 60 late deaths occurred from cancer (21), graft failure (13), infection (13), and miscellaneous (13). Retransplantations were performed in 11 patients. The actuarial survival of the entire cohort was 75%, 66% and 50% at 1, 5, and 10 years respectively.

Conclusions: Cardiac transplantation gives satisfactory long term results for patients with end-stage heart failure, providing good exercise tolerance and survival for 10 years or more in a large number of patients. Improvement in immunosuppression therapy is responsible for decrease in acute rejection rate. Reduction in HLA mismatch should allow for better immunomodulation and decreased incidence of cardiac allograft vasculopathy and malignancies.