Long-term survivor after heart transplantation at Stanford University

Background: Clinical human heart transplantation at Stanford University started 40 years ago. This single center study summarizes the improvements achieved over the past 4 decades and reports on our longest surviving heart transplant recipients. Methods: The Stanford Transplant Database and medical records of all cardiac transplants performed at our center were reviewed. Sixty pediatric and adult patients who were transplanted between 1968 and 1987 were identified who survived at least 20 years. Results: A total of 1446 heart transplantations have been performed between 1/1968 and 12/2007 with an increase of 1-year survival from 43.1% to 90.2%. Twentyyear survivors had a mean age at transplant of 29.4±13.6 years. Rejection-free and infection-free 1-year survivals were only 14.3% and 18.8%, respectively. At their last follow-up, 86.6% of long-term survivors were treated for hypertension, 28.3% showed chronic renal dysfunction, 6.7% required hemodialysis, 10% were status post kidney transplantation, 13.3% were treated for diabetes mellitus, 36.7% had developed some kind of malignancy and 43.3% showed graft CAD. The half-life conditional on survival to 20 years was 27.1 years. Eleven patients received a second heart transplant after 11.9±8.0 years. The most common causes of death were graft CAD (56.3%) and non-lymphoid malignancy (25.0%). Conclusions: Twenty-year survival was achieved in 12.5% of patients who received their heart transplant at Stanford University before 1988. Although still associated with considerable morbidity, long-term survival is expected to be achievable at much higher rates in the future due to the significant improvements of treatment options over the past decade.