Article

lock Open Access lock Peer-Reviewed

0

Views

ORIGINAL ARTICLE

Heart transplantation at the University of Minnesota

Luis Sérgio FragomeniI; Robert S BonserI; Jolene M KriettI; Michael P KayeI; Stuart W JamiesonI

ABSTRACT

Between January 1984 and December 1987, 117 heart transplants have been performed at the University of Minnesota. The indication for transplantation were end-stage heart failure due to ischemic heart disease (42%) and idiopathic cardiomiopathy (41%). The mean age of recipients was 45.2 years (mean 6 m-64 y). Immunosuppression with cyclospohne-A, azathioprine and prednisone was used in all cases. Actuarial survival was 95% at 1 year and 94% at 5 years. There were 7 deaths. Thirteen patients suffered one or more episodes of acute rejection diagnosed by endocardial biopsies. Graft atherosclerosis was assessed by annual coronary angiography. Abnormalities were demonstrated in 5 patients (7%) at 1 year, 5 patients (19%) at 2 years and a further 5 patients (38%) at 3 years. These results demonstrate that cardiac transplantation is a highly satisfactory therapy for end stage disease. The success of this program is attributed to careful donor/recipient selection, triple drug immunosupression and meticulous aftercare. The incidence of graft atherosclerosis is a major concern affecting late results of cardiac transplantation.

RESUMO

No período entre janeiro de 1984 e dezembro de 1987, foram realizados 117 transplantes de coração na Universidade de Minnesota. A indicação para transplante foi o estágio final de cardiopatia isquémica (42%) e miocardiopatia idiopática (41%). A idade média foi de 45,2 anos (6 meses-64 anos). Imunossupressão com ciclospotina-A, azatioprina e prednisona foi empregada em todos os casos. A curva atuarial de sobrevida no 1º ano é de 95%, no 5º ano é de 94%. Sete pacientes faleceram. Treze pacientes sofreram um ou mais episódios de rejeição, comprovados histológicamente através de biopsia endocárdica. Aterosclerose no coração transplantado foi investigada através de coronariografia anual. Foram identificadas anormalidades em 5 pacientes (7%) após o 1º ano, em 5 pacientes (19%) após o 2º ano e em outros 5 pacientes (38%) após o 3º ano. O sucesso desta opção terapêutica e deste programa está relacionado à criteriosa seleção doador/receptor, à imunossupressão com terapia tríplice e meticuloso cuidado pós-operatório. Aterosclerose coronária progressiva permanece a principal causa que, atualmente, afeta os resultados a longo prazo do transplante cardíaco.
Full text available only in portuguese PDF format.

REFERENCES

1. ANDREONE, P. A.; OLIVARI, M. T.; ELICK, B.; ARENTZEN, C. E.; SIBLEY, R. K.; BOLMAN, R. M.; SIMMONS, R. L.; RING, W. S. - Reduction of infectious complications following heart transplantation with triple drug immunotherapy. J. Heart Transpl., 5(1): 13-19, 1986.

2. BARNARD, C. N. - A human cardiac transplant: an interin report of a successful operation performed at Groote Schur Hospital, Capetown, South Africa. S. Afr. Med. J., 41: 1721-1274, 1967.

3. CAVES, P. K.; STINSON, E. B.; BILLINGHAM, M. E.; SHUMWAY, N. E. - Percutaneous transvenous endomyocardial biopsy in human heart recipients. Ann. Thorac. Surg., 16(4): 325-336, 1973. [MedLine]

4. COHEN, D. J.; LOERTSCHER, R.; RUBIN, M. F.; TILNEY, N. L.; CARPENTIER, C. B.; STROM, T. B. - Cyclosporine: a new immunosupressive agent for organ transplantation. Ann. Int. Med., 101(5): 667-682, 1984.

5. ERICE, A.; JORDAN, M. C.; CHACE, R. N.: FLETCHER, C.; CHINNOCK, B. J.; BALFOUR, H. H. - Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts. JAMA, 257(22): 3082-3087, 1987. [MedLine]

6. FRAGOMENI, L. S. & KAYE, M. P. - The registry of the International Society for Heart Transplantation: fifth-official report - 1988. J. Heart Transpl. (No prelo).

7. HUNT, S. A. - Complications of heart transplantation. J. Heart Transpl., 3(1): 70-74, 1983.

8. MASON, J. W.; STINSON, E. B.; HUNT, S. A.; SCHROEDER, J. S.; RIDER, A. K. - Infections after cardiac transplantation: relation to rejection therapy. Ann. Int. Med., 85(1): 69-72, 1976.

9. SIBLEY, R. K.; OLIVARI, M. T.; BOLMAN, R. M.; RING, W. S. - Endomyocardial biopsy in the cardiac allograf recipient: a review of 570 biopsies. Ann. Surg., 203(2): 177-187, 1986. [MedLine]

10. THOMAS, F. T.; SZABOLCS, S.; SZENTPETERY, S.; MAMMANA, R. E.; WOLFGANG, T. C.; LOWER, R. R. - Long distance transportation of human hearts for transplantation. Ann. Thorac. Surg., 26(4): 344, 350, 1978.

11. URETZKY, B. F.; MURALI, S.; LEE, A.; REDDY, P. S.; GRIFFITH, B. P.; HARDESTY, R. L.; TRENTO, A.; BAHNSON, H. T. - Development of coronary atherosclerosis in the transplanted heart immunosupressed with cyclosporine and prednisone. J. Am. Coll. Cardiol., 7(Supl. A): 9A, 1986. [MedLine]

12. WATSON, D. C.; REITZ, B. A.; BAUMGARTNER, W. A.; RANEY, A. A.; OYER, P. E.; STINSON, E. B.; SHUMWAY, N. E. - Distant heart procurement for transplantation. Surgery, 86(1): 56-59, 1979. [MedLine]

Article receive on Friday, June 10, 1988

CCBY All scientific articles published at bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2020 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY