Great enthusiasm and high hopes followed the first heart transplant carried out in South Africa in 1967. Heart transplants followed quickly in the U.S., but, because of wretched outcomes, heart transplant programs in the U.S. soon came to a halt except at Stanford Medical Center. But that has changed in recent years.
Better Immunosuppressive Drugs
A new era of transplants was ushered in with the availability of better immunosuppressive drugs in about 1980. These drugs suppress the body's natural immune system, which is beneficial because otherwise the body would naturally try to fight off the newly transplanted heart. In addition, the new drugs improved prevention and treatment of infections. Since then, post-transplant survival has improved steadily. As of June 2009, the 5-year survival was 73 percent in men and 69 percent in women. The longest survivor died of cancer 31 years after heart transplantation.
Factors Contributing to 10 Year Survival
A study carried out at Johns Hopkins, published in March 2012 in Annals of Thoracic Surgery, compared those who survived a first heart transplant for 10 years or more with a control group who survived for less than 10 years during the period 1987 to 1999. Included in the study were those over the age of 18; only 21 percent were women and 16 percent were Black. Average age was 55 years. Contributing significantly to 10-year survival were features of the transplanted patients, condition of the donor heart, and site of transplantation.
Patient features that improved 10 year survival
Younger than 55 years of age
Underlying cardiomyopathy or heart valve disease rather than coronary heart disease
Patient features that diminished survival
Prior requirement for mechanical ventilation
Qualities of donor heart that improved survival
Younger age of donor
Shorter time between removal of donor heart and its implantation
Survival was 31 percent greater for transplants done at centers which carried out 9 or more heart transplants annually
Survival was somewhat better in those operated on latter during the study period, showing better outcomes even during this short 12 years of the study. Overall, nearly half of the patients in this study survived for 10 years or more after their heart transplant.
Possible Impact of the Findings for Future Choice of Transplant Patients
Heart transplant is now the “gold standard” treatment for patients with severe, end-stage heart failure that does not respond to life style measures and medication.
The problem: less than 2,500 hearts are available annually for the much larger number of people who meet the criteria for a heart transplant. Present selection rules for transplantation are based strictly on which patients are sickest in the national donor list. The authors of the present research paper suggest that “likelihood of survival” should be added to the criteria of “sickest” to decide the order in which heart transplant patients are chosen. This is because those sickest patients might also be the ones who have the worst survival rate after transplant.