Present Expectations in Cardiac Transplantation

The clinical introduction of cyclosporine has resulted in increased enthusiasm for cardiac transplantation. Since July, 1983, 61 patients (50 male and 11 female) have undergone orthotopic cardiac transplantation for cardiomyopathy (48 patients), ischemic heart disease (11), or congenital heart disease (2). Mean age was 39 years (range, 1.5 to 57 years). Median hospital stay was 26 days (range, 4 to 60 days). Maintenance immunosuppression consisted primarily of prednisone and cyclosporine; it was modified in 9 patients because of a pre-existing clinical condition. The incidence of rejection was 0.44 episode/patient-month within 3 months of cardiac transplantation and 0.10 episode/patient-month subsequently. The incidence of infection was 0.05 episode/patient-month. Major side effects of cyclosporine included renal dysfunction (63%) and hypertension (61%). No recipient required dialysis for renal dysfunction. Ten patients died (rejection, 4; infection, 3; carcinoma, 1; lymphoma, 1; and pulmonary hemorrhage, 1); actuarial survival at 1 and 2 years was 84 ± 6% and 76 ± 8%, respectively. Patient follow-up (cumulative, 719 patient-months) revealed that 96% of recipients were rehabilitated and 50% had returned to work. With increasing understanding of cyclosporine immunosuppression, recipients can continue to look forward to an extended life with nearly complete rehabilitation.