Open AccessLong‐term outcomes after 1000 heart transplantations in six different eras of innovation in a single center
Author(s) -
Kofler Sieglinde,
Bigdeli Amir K.,
Kaczmarek Ingo,
Kellerer Diana,
Müller Thomas,
Schmoeckel Michael,
Steinbeck Gerhard,
Überfuhr Peter,
Reichart Bruno,
Meiser Bruno
Publication year - 2009
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2009.00931.x
Subject(s) - medicine , tacrolimus , heart transplantation , single center , sirolimus , cardiac allograft vasculopathy , transplantation , ventricular assist device , retrospective cohort study , cardiology , surgery , urology , heart failure
Summary The objective of this study was to evaluate long‐term outcomes of cardiac transplantation (HTx) in different eras of innovation at a single center during a period of 27 years. We performed a retrospective analysis of 960 cardiac allograft recipients (40 re‐HTx) between 1981 and 2008. The results of six different eras based on milestones in HTx were analysed: Era 1: the early years ( n = 222, 1981–1992); era 2: introduction of inhalative nitric oxide, prostanoids, University of Wisconsin solution (UW) replacing Bretschneider’s solution (HTK, n = 118, 1992–1994); era 3: statins ( n = 102, 1994–1995); era 4: tacrolimus ( n = 115, 1995–1996); era 5: mycophenolate mofetil (MMF, n = 143, 1997–2000) and era 6: sirolimus ( n = 300, 2000–2008). Outcome variables were survival, freedom from cardiac allograft vasculopathy (CAV) and from acute rejection episodes (AREs). Differences in survival was found comparing era 1 and era 2 with era 4 and era 6 ( P < 0.001). Organ preservation through UW demonstrated a significantly better survival as compared with HTK ( P < 0.001). Less AREs occurred in patients receiving tacrolimus‐sirolimus or tacrolimus‐MMF ( P < 0.001). Patients receiving tacrolimus‐MMF showed less CAV than when treated with cyclosporine‐MMF ( P < 0.005). There were more ventricular assist device implantations and more re‐HTx in era 6 ( P < 0.0001) than when compared with other eras. Although the causes for improvement in survival over time are multifactorial, we believe that changes in immunosuppressive therapy have had a major impact on survival.