Abstract
In summary, our study suggests no significant correlation between survival status and diabetes mellitus, between survival status and arterial hypertension, or between survival and the presence of cancer. However, we observed a significant correlation between survival status and hyperlipoproteinemia. Furthermore, the mortality rates among patients with cellular, humoral, and cellular-humoral diseases were found to be lower than the mortality rate of patients without rejection. Thus, a statistically significant correlation between survival status and rejection is evident. The discrepancy in survival status in relation to the age of patients was also significant. These findings highlight the importance of preventing hyperlipoproteinemia to support a long and healthy life. In addition, to reduce mortality, the likelihood of rejection should be minimized as much as possible. Finally, each potential recipient should be evaluated in terms of individual risk and benefit from the procedure.
Variables that contribute to long-term mortality may include recipient and donor age, recipient and donor body mass index, lifestyle, length of hospital stay, and time of ischemia. More comprehensive studies are needed for the variables that contribute to long-term mortality. This is one of the limitations of our study.
Keywords
heart transplantation; transplantation; graft rejection; survival; heart failure; mortality
Project Number
Project no KA20 / 326
References
- 1. Taylor DO, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report-2008. J Heart Lung Transplant 2008;27:943–56. (doi: 10.1016/j.healun.2008.06.017).
- 2. Costanzo MR, Augustine S, Bourge R, et al. Selection and treatment of candidates for heart transplantation. A statement for health professionals from the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. Circulation 1995;92:3593-612. (doi: 10.1161/01.cir.92.12.3593).
- 3. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the american college of cardiology foundation/american heart association task force on practice guidelines: Developed in collaboration with the international society for heart and lung transplantation. Circulation 2009;119:1977-2016. (doi: 10.1161/CIRCULATIONAHA.109.192064).
- 4. Soukiasian HJ, Czer LS, Wang HM, et al. Inhibition of graft coronary arteriosclerosis after heart transplantation. Am Surg 2004;70(10):833-40. (PMID: 15529833).
- 5. Trevizan FB, Miyazaki MCOS, Silva YLW, and Roque CMW. Quality of Life, Depression, Anxiety and Coping Strategies after Heart Transplantation. Braz J Cardiovasc Surg 2017; 32(3): 162–170. (doi: 10.21470/1678-9741-2017-29).
- 6. Vaseghi M, Lellouche N, Ritter H, et al. Michael C. Fishbein, Mode and mechanisms of death followıng orthotopıc heart transplantatıon. Heart Rhythm 2009; 6(4): 503–09. (doi: 10.1016/j.hrthm.2009.01.005).
- 7. Al-Kindi SG, Sarode A, Zullo M, et al. Ambient Air Pollution and Mortality After Cardiac Transplantation. J Am Coll Cardiol 2019;74(24):3026-35. (doi: 10.1016/j.jacc.2019.09.066).
- 8. Cipullo R, Finger MA, Ponce F, et al. Renal failure as a determinant of mortality after cardiac transplantation. Transplant Proc 2004;36(4):989-90. (doi: 10.1016/j.transproceed.2004.03).
- 9. Padmanabhan H, Brookes MJ, Luckraz H. Association between Anemia and Blood Transfusion with Long-Term Mortality after Cardiac Surgery. Ann Thorac Surg 2020;110(2):749-50. (doi: 10.1016/j.athoracsur.2020.02.043).
- 10. Van Keeer J, Droogne W, Van Cleemput J, et al. Cancer After Heart Transplantation: A 25-year Single-center Perspective. Transplant Proc 2016;48(6):2172-77. (doi: 10.1016/j.transproceed.2016.03.037).
- 11. Aziz T, el-Gamel A, Krysiak P, et al. Risk factors for early mortality, acute rejection, and factors affecting first-year survival after heart transplantation. Transplant Proc 1998;30(5):1912-14. (doi: 10.1016/s0041-1345(98)00479-5).
- 12. Desruennes M, Drobinski G, Chomette G, et al. Coronary pathology after heart transplantatin. Presse Med 1992;21(14):670-75. (PMID: 1317962).
- 13. Camkiran FA, Komurcu O, Zeyneloglu P, Turker M, Sezgin A, Pirat A. Early Postoperative Pulmonary Complications After Heart Transplantation. Transplant Proc 2015;47(4):1214-16. (doi: 10.1016/j.transproceed.2014.11.058).
- 14. Escoresca Ortega AM, Ruiz de Azua Lopez Z, Hinojosa Perez R, et al. Kidney Failure After Heart Transplantation. Transplant Proc 2010;42(8):3193-95. (doi: 10.1016/j.transproceed.2010.05.049).
- 15. Mingo-Santos S, Monivas-Palomero V, Garcia-Lunar I, et al. Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. J Am Soc Echocardiogr, 2015;28(10):1149-56 (doi: 10.1016/j.echo.2015.06.005).
- 16. Schweiger M, Wasler A, Prenner G, Tripolt M, Schwarz M, Tscheliessnigg KH. Late acute cardiac allograft rejection: new therapeutic options? Transplant Proc 2005;37(10):4528-31. (doi: 10.1016/j.transproceed.2005.11.053).
- 17. Olivari MT, Homans DC, Wilson RF, Kubo SH, Ring WS. Coronary artery disease in cardiac transplant patients receiving triple-drug immunosuppressive therapy. Circulation 1989;80(5 Pt 2):III111-15. (PMID: 2805289).
- 18. Dhara Singh, Immunosuppresson for postcardac transplant patients, Journal of the practice of cardiovascular sciences, 2018;159-63. (doi: 10.4103/jpcs.jpcs_56_18).
- 19. Grimm M, Rinaldi M, Yonan NA, et al. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients – A large European trial. Am J Transplant.2006;6:1387-97. (doi: 10.1111/j.1600-6143.2006.01300.x).
- 20. Hirohata A, Nakamura M, Waseda K, et al. Changes in Coronary Anatomy and Physiology After Heart Transplantation. Am J Cardiol 2007;99(11):1603-07. (doi: 10.1016/j.amjcard.2007.01.039).
- 21. Patel JK, Kittleson M,Kobashigawa JA. Cardiac allograft rejection. Surgen 2011;9(3):160-67. (doi: 10.1016/j.surge.2010.11.023).
- 22. Kim IC, Youn JC, Kobashigawa JA. The Past, Present and Future of Heart Transplantation. Korean Circ J 2018;48(7):565-590. (doi: 10.4070/kcj.2018.0189).
- 23. Subherwal S, Kobashigawa JA, Cogert G, Patel J, Espejo M, Oeser B. Incidence of acute cellular rejection and non-cellular rejection in cardiac transplantation. Transplant Proc 2004;36(10):3171-72. (doi: 10.1016/j.transproceed.2004.10.048).
- 24. Kittleson MM, Patel JK, Kobashigawa JA. Chapter 72: cardiac transplantation. In: Fuster V, Harrington RA, Narula J, Eapen ZJ, editors. Hurst's the Heart. 14th ed. New York: McGraw-Hill; 2017.
- 25. Dantal J, Soulillou JP. Immunosuppressive drugs and the risk of cancer after organ transplantation. N Engl J Med 2005;352:1371–73. (doi: 10.1056/NEJMe058018).
- 26. Gupta D, Piacentino V 3rd, Macha M, et al. Effect of older donor age on risk for mortalitt after heart transplantation. Ann Thorac Surg 2004;78(3):890-99. (doi: 10.1016/j.athoracsur.2004.02.016).
- 27. Daneshvar D, Czer LS, Phan A, Schwarz ER, De Robertis M, Mirocha J. Heart Transplantation in Patients Aged 70 Years and Older: A Two-Decade Experience. Transplant Proc 2011;43(10):3851-56. (doi: 10.1016/j.transproceed.2011.08.086).
- 28. Bianco JC, Mc Loughlin S, Denault AY, Marenchino RG, Rojas JI, Bonofiglio FC. Heart Transplantation in Patients >60 Years: İmportance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival. J Cardiothorac Vasc Anesth 2018;32(1):32-40. (doi: 10.1053/j.jvca.2017.09.017).
- 29. Bull DA, Karwande SV, Hawkins JA, et al. Long-term results of cardiac transplantation in patients over sixty years. J Thorac Cardiovasc Surg 1996;111:423–28. (doi: 10.1016/s0022-5223(96)70452-x).
Abstract
Aim: Heart transplantation is currently considered the optimal surgical approach for the treatment of refractory heart failure, as it offers a higher likelihood of survival as well as
significant improvements to quality of life. We aim to identify factors that relate to
post-transplantation survival among patients who received a cardiac transplantation.
Material and Methods: We retrospectively included all cardiac transplant recipients who
underwent cardiac transplant operations at the Başkent University Faculty of Medicine
between February 1, 2003 and December 1, 2019. We examined various demographic and clinical factors. This study was approved by the Başkent University Medical and Health Sciences Research Board (Project no KA20 / 326) and supported by the Başkent University Research Fund. The principles of the Declaration of Helsinki were complied with during the study.
Results: A total of 99 patients were involved in the study. The mean age was
41.65 ± 14.89 years. The underlying cardiac condition for cardiac transplantation was ischemic dilated cardiomyopathy in 20 patients (20.2%),non-ischemic dilated cardiomyopathy in 66 patients (66.7%),restrictive cardiomyopathy in five patients (5.1%),myocarditis in one patient (1.0%),and another cause in seven patients (7.1%). Binary logistic regression analysis indicates that transplant rejection was the sole independent predictor of mortality.
Conclusion: The survival of cardiac transplant recipients is significantly correlated to
transplant rejection and patient age. However, we observed a significant correlation between survival status and hyperlipoproteinemia. Furthermore, the mortality rates among patients with cellular, humoral, and cellular-humoral diseases were found to be lower than the mortality rate of patients without rejection.
KEYWORDS: heart transplantation; transplantation; graft rejection; survival; heart failure;
mortality
Supporting Institution
Başkent University Research Fund
Project Number
Project no KA20 / 326
Thanks
At this point I would like to thank everyone involved. Thank you for helping me with the preparation of my article. My special thanks go to Dr. Arzu Neslihan Akgün, who helped me with patient search and identification. I would also like to thank Prof. Dr. Atilla Sezgin for his excellent surgical work. I would especially like to thank my clinic manager Prof. Dr Haldun Müderrisoğlu for the enormous support in carrying out and implementing the entire work.
References
- 1. Taylor DO, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report-2008. J Heart Lung Transplant 2008;27:943–56. (doi: 10.1016/j.healun.2008.06.017).
- 2. Costanzo MR, Augustine S, Bourge R, et al. Selection and treatment of candidates for heart transplantation. A statement for health professionals from the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. Circulation 1995;92:3593-612. (doi: 10.1161/01.cir.92.12.3593).
- 3. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the american college of cardiology foundation/american heart association task force on practice guidelines: Developed in collaboration with the international society for heart and lung transplantation. Circulation 2009;119:1977-2016. (doi: 10.1161/CIRCULATIONAHA.109.192064).
- 4. Soukiasian HJ, Czer LS, Wang HM, et al. Inhibition of graft coronary arteriosclerosis after heart transplantation. Am Surg 2004;70(10):833-40. (PMID: 15529833).
- 5. Trevizan FB, Miyazaki MCOS, Silva YLW, and Roque CMW. Quality of Life, Depression, Anxiety and Coping Strategies after Heart Transplantation. Braz J Cardiovasc Surg 2017; 32(3): 162–170. (doi: 10.21470/1678-9741-2017-29).
- 6. Vaseghi M, Lellouche N, Ritter H, et al. Michael C. Fishbein, Mode and mechanisms of death followıng orthotopıc heart transplantatıon. Heart Rhythm 2009; 6(4): 503–09. (doi: 10.1016/j.hrthm.2009.01.005).
- 7. Al-Kindi SG, Sarode A, Zullo M, et al. Ambient Air Pollution and Mortality After Cardiac Transplantation. J Am Coll Cardiol 2019;74(24):3026-35. (doi: 10.1016/j.jacc.2019.09.066).
- 8. Cipullo R, Finger MA, Ponce F, et al. Renal failure as a determinant of mortality after cardiac transplantation. Transplant Proc 2004;36(4):989-90. (doi: 10.1016/j.transproceed.2004.03).
- 9. Padmanabhan H, Brookes MJ, Luckraz H. Association between Anemia and Blood Transfusion with Long-Term Mortality after Cardiac Surgery. Ann Thorac Surg 2020;110(2):749-50. (doi: 10.1016/j.athoracsur.2020.02.043).
- 10. Van Keeer J, Droogne W, Van Cleemput J, et al. Cancer After Heart Transplantation: A 25-year Single-center Perspective. Transplant Proc 2016;48(6):2172-77. (doi: 10.1016/j.transproceed.2016.03.037).
- 11. Aziz T, el-Gamel A, Krysiak P, et al. Risk factors for early mortality, acute rejection, and factors affecting first-year survival after heart transplantation. Transplant Proc 1998;30(5):1912-14. (doi: 10.1016/s0041-1345(98)00479-5).
- 12. Desruennes M, Drobinski G, Chomette G, et al. Coronary pathology after heart transplantatin. Presse Med 1992;21(14):670-75. (PMID: 1317962).
- 13. Camkiran FA, Komurcu O, Zeyneloglu P, Turker M, Sezgin A, Pirat A. Early Postoperative Pulmonary Complications After Heart Transplantation. Transplant Proc 2015;47(4):1214-16. (doi: 10.1016/j.transproceed.2014.11.058).
- 14. Escoresca Ortega AM, Ruiz de Azua Lopez Z, Hinojosa Perez R, et al. Kidney Failure After Heart Transplantation. Transplant Proc 2010;42(8):3193-95. (doi: 10.1016/j.transproceed.2010.05.049).
- 15. Mingo-Santos S, Monivas-Palomero V, Garcia-Lunar I, et al. Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. J Am Soc Echocardiogr, 2015;28(10):1149-56 (doi: 10.1016/j.echo.2015.06.005).
- 16. Schweiger M, Wasler A, Prenner G, Tripolt M, Schwarz M, Tscheliessnigg KH. Late acute cardiac allograft rejection: new therapeutic options? Transplant Proc 2005;37(10):4528-31. (doi: 10.1016/j.transproceed.2005.11.053).
- 17. Olivari MT, Homans DC, Wilson RF, Kubo SH, Ring WS. Coronary artery disease in cardiac transplant patients receiving triple-drug immunosuppressive therapy. Circulation 1989;80(5 Pt 2):III111-15. (PMID: 2805289).
- 18. Dhara Singh, Immunosuppresson for postcardac transplant patients, Journal of the practice of cardiovascular sciences, 2018;159-63. (doi: 10.4103/jpcs.jpcs_56_18).
- 19. Grimm M, Rinaldi M, Yonan NA, et al. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients – A large European trial. Am J Transplant.2006;6:1387-97. (doi: 10.1111/j.1600-6143.2006.01300.x).
- 20. Hirohata A, Nakamura M, Waseda K, et al. Changes in Coronary Anatomy and Physiology After Heart Transplantation. Am J Cardiol 2007;99(11):1603-07. (doi: 10.1016/j.amjcard.2007.01.039).
- 21. Patel JK, Kittleson M,Kobashigawa JA. Cardiac allograft rejection. Surgen 2011;9(3):160-67. (doi: 10.1016/j.surge.2010.11.023).
- 22. Kim IC, Youn JC, Kobashigawa JA. The Past, Present and Future of Heart Transplantation. Korean Circ J 2018;48(7):565-590. (doi: 10.4070/kcj.2018.0189).
- 23. Subherwal S, Kobashigawa JA, Cogert G, Patel J, Espejo M, Oeser B. Incidence of acute cellular rejection and non-cellular rejection in cardiac transplantation. Transplant Proc 2004;36(10):3171-72. (doi: 10.1016/j.transproceed.2004.10.048).
- 24. Kittleson MM, Patel JK, Kobashigawa JA. Chapter 72: cardiac transplantation. In: Fuster V, Harrington RA, Narula J, Eapen ZJ, editors. Hurst's the Heart. 14th ed. New York: McGraw-Hill; 2017.
- 25. Dantal J, Soulillou JP. Immunosuppressive drugs and the risk of cancer after organ transplantation. N Engl J Med 2005;352:1371–73. (doi: 10.1056/NEJMe058018).
- 26. Gupta D, Piacentino V 3rd, Macha M, et al. Effect of older donor age on risk for mortalitt after heart transplantation. Ann Thorac Surg 2004;78(3):890-99. (doi: 10.1016/j.athoracsur.2004.02.016).
- 27. Daneshvar D, Czer LS, Phan A, Schwarz ER, De Robertis M, Mirocha J. Heart Transplantation in Patients Aged 70 Years and Older: A Two-Decade Experience. Transplant Proc 2011;43(10):3851-56. (doi: 10.1016/j.transproceed.2011.08.086).
- 28. Bianco JC, Mc Loughlin S, Denault AY, Marenchino RG, Rojas JI, Bonofiglio FC. Heart Transplantation in Patients >60 Years: İmportance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival. J Cardiothorac Vasc Anesth 2018;32(1):32-40. (doi: 10.1053/j.jvca.2017.09.017).
- 29. Bull DA, Karwande SV, Hawkins JA, et al. Long-term results of cardiac transplantation in patients over sixty years. J Thorac Cardiovasc Surg 1996;111:423–28. (doi: 10.1016/s0022-5223(96)70452-x).
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Orıgınal Artıcle |
| Authors | |
| Project Number | Project no KA20 / 326 |
| Publication Date | September 27, 2022 |
| Published in Issue | Year 2022 Volume: 13 Issue: 3 |
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e-ISSN: 2149-8296
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