Heart transplantation prognosis: Difference between revisions

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{{Heart transplantation}}
{{Heart transplantation}}


'''Editor(s)-in-Chief:''' [[C. Michael  Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}
'''Editor(s)-in-Chief:''' [[C. Michael  Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}{{IF}}
 
==Overview==
The [[prognosis]] of the patient depends on a number of [[donor]] and recipient factors. If left untreated, patients develop acute [[graft rejection]]. Common complications of cardiac transplant include [[Graft rejection|acute graft rejection]], graft failure, [[Infection|infections]], [[Cardiac allograft vasculopathy]] (CAV), [[Cancer|malignancies]], and late [[graft rejection]].


==Prognosis==
==Prognosis==
Factors determining prognosis
* Depending on the various factors of the donor and recipient at the time of transplant, the prognosis may vary.
* Donor factors-
* Prognosis is generally regarded as good. The 1-year survival is 84.5% and 5-year survival is 72.5%. <ref name="pmid25242124">{{cite journal| author=Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI | display-authors=etal| title=The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report--2014; focus theme: retransplantation. | journal=J Heart Lung Transplant | year= 2014 | volume= 33 | issue= 10 | pages= 996-1008 | pmid=25242124 | doi=10.1016/j.healun.2014.08.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25242124  }} </ref>
**Advanced donor age
* Post-transplant [[survival]] has improved over time.
**prolonged ischemia time
* The median survival after adult heart transplants performed between 2002 and 2009 is 12.5 years, which extends to 14.8 years among 1-year survivors. <ref name="pmid31548031">{{cite journal| author=Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Hsich E | display-authors=etal| title=The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. | journal=J Heart Lung Transplant | year= 2019 | volume= 38 | issue= 10 | pages= 1056-1066 | pmid=31548031 | doi=10.1016/j.healun.2019.08.004 | pmc=6816343 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31548031  }} </ref>
 
The following are the factors determining [[prognosis]]-
=== Donor factors===
Both the following factors are associated with an increased one-year mortality rate in the recipient.
*Advanced donor age <ref name="PotapovLoebe1999">{{cite journal|last1=Potapov|first1=Evgenij V.|last2=Loebe|first2=Matthias|last3=H??bler|first3=Michael|last4=Musci|first4=Michele|last5=Hummel|first5=Manfred|last6=Weng|first6=Yu-guo|last7=Hetzer|first7=Roland|title=MEDIUM-TERM RESULTS OF HEART TRANSPLANTATION USING DONORS OVER 63 YEARS OF AGE1|journal=Transplantation|volume=68|issue=12|year=1999|pages=1834–1838|issn=0041-1337|doi=10.1097/00007890-199912270-00002}}</ref>
*Prolonged [[ischemia]] time


* Recipient factors-
===Recipient factors===
** The greatest one-year mortality was seen with the use of total artificial heart as a bridge to transplant or a need for end-organ support with mechanical ventilation or dialysis.
* Use of total artificial heart as a bridge to transplant or a need for end-organ support in the form of [[mechanical ventilation]] or [[dialysis]]- associated with the greatest one-year mortality
** Best prognosis is seen if the indication for transplant is ischemic and nonischemic cardiomyopathy, whereas patients with a history of congenital heart disease, restrictive cardiomyopathy, and those undergoing retransplantation have worse prognosis.
* Best prognosis is seen if the indication for transplant is [[ischemic]] and [[nonischemic cardiomyopathy]] <ref name="KhushCherikh2018">{{cite journal|last1=Khush|first1=Kiran K.|last2=Cherikh|first2=Wida S.|last3=Chambers|first3=Daniel C.|last4=Goldfarb|first4=Samuel|last5=Hayes|first5=Don|last6=Kucheryavaya|first6=Anna Y.|last7=Levvey|first7=Bronwyn J.|last8=Meiser|first8=Bruno|last9=Rossano|first9=Joseph W.|last10=Stehlik|first10=Josef|title=The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report—2018; Focus Theme: Multiorgan Transplantation|journal=The Journal of Heart and Lung Transplantation|volume=37|issue=10|year=2018|pages=1155–1168|issn=10532498|doi=10.1016/j.healun.2018.07.022}}</ref>
** Younger recipients (below age 55) have an advantage
** Pre-transplant serum creatinine and total bilirubin are linearly related to survival.


Some other risk factors related to the recipient are:
* Patients with a history of [[congenital heart disease]], [[restrictive cardiomyopathy]], and those undergoing retransplantation have a worse prognosis.
* Use of Amiodarone pretransplantation
* Younger recipients (below age 55) have an advantage
* Prior cardiac surgery
* Pre-transplant serum [[creatinine]] and total [[bilirubin]] are linearly related to survival.
* Transplantation of a female heart into a male or female recipient


Post-transplant survival has improved over time.  
Some other risk factors are:
The median survival after adult heart transplants performed between 2002 and 2009 is 12.5 years, which extends to 14.8 years among 1-year survivors. <ref name="pmid31548031">{{cite journal| author=Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Hsich E | display-authors=etal| title=The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. | journal=J Heart Lung Transplant | year= 2019 | volume= 38 | issue= 10 | pages= 1056-1066 | pmid=31548031 | doi=10.1016/j.healun.2019.08.004 | pmc=6816343 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31548031 }} </ref>
* Use of [[Amiodarone]] pretransplantation  <ref name="pmid27520780">{{cite journal| author=Cooper LB, Mentz RJ, Edwards LB, Wilk AR, Rogers JG, Patel CB | display-authors=etal| title=Amiodarone use in patients listed for heart transplant is associated with increased 1-year post-transplant mortality. | journal=J Heart Lung Transplant | year= 2017 | volume= 36 | issue= 2 | pages= 202-210 | pmid=27520780 | doi=10.1016/j.healun.2016.07.009 | pmc=5241253 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27520780  }} </ref>
* [[Hypertension]]
* [[Hypercholesterolemia]] <ref name="pmid22308287">{{cite journal| author=Singh TP, Almond CS, Semigran MJ, Piercey G, Gauvreau K| title=Risk prediction for early in-hospital mortality following heart transplantation in the United States. | journal=Circ Heart Fail | year= 2012 | volume= 5 | issue= 2 | pages= 259-66 | pmid=22308287 | doi=10.1161/CIRCHEARTFAILURE.111.965996 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22308287  }} </ref> <ref name="pmid2361019">{{cite journal| author=Radovancevic B, Poindexter S, Birovljev S, Velebit V, McAllister HA, Duncan JM | display-authors=etal| title=Risk factors for development of accelerated coronary artery disease in cardiac transplant recipients. | journal=Eur J Cardiothorac Surg | year= 1990 | volume= 4 | issue= 6 | pages= 309-12; discussion 313 | pmid=2361019 | doi=10.1016/1010-7940(90)90207-g | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2361019  }} </ref>
* [[Diabetes]]
* [[Renal insufficiency]]
* Use of specific [[immunosuppressive]] regimen
* Elevated [[body mass index]]
* [[Tobacco]] use
* [[Obesity]]
* Early post-[[transplant]] [[complications]]
* Prior [[cardiac surgery]]
* Transplantation of a [[female]] [[heart]] into a [[male]] or [[female]] recipient. <ref name="pmid9456101">{{cite journal| author=Prendergast TW, Furukawa S, Beyer AJ, Browne BJ, Eisen HJ, Jeevanandam V| title=The role of gender in heart transplantation. | journal=Ann Thorac Surg | year= 1998 | volume= 65 | issue= 1 | pages= 88-94 | pmid=9456101 | doi=10.1016/s0003-4975(97)01105-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9456101 }} </ref>


Tony Huesman was the world's longest-living heart transplant patient, having survived for 28 years with a transplanted heart. Huesman received a heart transplant in 1978 at Stanford University under American heart transplant pioneer [[Norman Shumway|Dr. Norman Shumway]], <ref>[http://www.cbsnews.com/stories/2006/09/14/ap/health/mainD8K49NG86.shtml Heart Transplant Patient OK After 28 Yrs] (September 14, 2006) ''CBS News''. Retrieved December 29, 2006.</ref>
===Complications and Causes of Death after Transplantation===
The following table outlines the common causes of death in post-[[Heart transplantation|cardiac transplant]] patients <ref name="MontoyaGiraldo2001">{{cite journal|last1=Montoya|first1=Jose G.|last2=Giraldo|first2=Luis F.|last3=Efron|first3=Bradley|last4=Stinson|first4=Edward B.|last5=Gamberg|first5=Pat|last6=Hunt|first6=Sharon|last7=Giannetti|first7=Nadia|last8=Miller|first8=Joan|last9=Remington|first9=Jack S.|title=Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center|journal=Clinical Infectious Diseases|volume=33|issue=5|year=2001|pages=629–640|issn=1058-4838|doi=10.1086/322733}}</ref>


==Causes of Death after Transplantation==
The following table outlines the common causes of death in post-cardiac transplant patients


{|class="wikitable" border="1"
{|class="wikitable" border="1"

Latest revision as of 20:23, 15 July 2020

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]

Overview

The prognosis of the patient depends on a number of donor and recipient factors. If left untreated, patients develop acute graft rejection. Common complications of cardiac transplant include acute graft rejection, graft failure, infections, Cardiac allograft vasculopathy (CAV), malignancies, and late graft rejection.

Prognosis

  • Depending on the various factors of the donor and recipient at the time of transplant, the prognosis may vary.
  • Prognosis is generally regarded as good. The 1-year survival is 84.5% and 5-year survival is 72.5%. [1]
  • Post-transplant survival has improved over time.
  • The median survival after adult heart transplants performed between 2002 and 2009 is 12.5 years, which extends to 14.8 years among 1-year survivors. [2]

The following are the factors determining prognosis-

Donor factors

Both the following factors are associated with an increased one-year mortality rate in the recipient.

Recipient factors

Some other risk factors are:

Complications and Causes of Death after Transplantation

The following table outlines the common causes of death in post-cardiac transplant patients [9]


First 30 days post-transplant From 1 month to 12 months post-transplant After 5 years post-transplant
  • Cardiac allograft vasculopathy (CAV)
  • Late graft failure (Both together accounting for 33% of deaths)
  • Malignancies (23%)
  • Non-CMV infections (11%)

References

  1. ↑ Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI; et al. (2014). "The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report--2014; focus theme: retransplantation". J Heart Lung Transplant. 33 (10): 996–1008. doi:10.1016/j.healun.2014.08.003. PMID 25242124.
  2. ↑ Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Hsich E; et al. (2019). "The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match". J Heart Lung Transplant. 38 (10): 1056–1066. doi:10.1016/j.healun.2019.08.004. PMC 6816343 Check |pmc= value (help). PMID 31548031.
  3. ↑ Potapov, Evgenij V.; Loebe, Matthias; H??bler, Michael; Musci, Michele; Hummel, Manfred; Weng, Yu-guo; Hetzer, Roland (1999). "MEDIUM-TERM RESULTS OF HEART TRANSPLANTATION USING DONORS OVER 63 YEARS OF AGE1". Transplantation. 68 (12): 1834–1838. doi:10.1097/00007890-199912270-00002. ISSN 0041-1337.
  4. ↑ Khush, Kiran K.; Cherikh, Wida S.; Chambers, Daniel C.; Goldfarb, Samuel; Hayes, Don; Kucheryavaya, Anna Y.; Levvey, Bronwyn J.; Meiser, Bruno; Rossano, Joseph W.; Stehlik, Josef (2018). "The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report—2018; Focus Theme: Multiorgan Transplantation". The Journal of Heart and Lung Transplantation. 37 (10): 1155–1168. doi:10.1016/j.healun.2018.07.022. ISSN 1053-2498.
  5. ↑ Cooper LB, Mentz RJ, Edwards LB, Wilk AR, Rogers JG, Patel CB; et al. (2017). "Amiodarone use in patients listed for heart transplant is associated with increased 1-year post-transplant mortality". J Heart Lung Transplant. 36 (2): 202–210. doi:10.1016/j.healun.2016.07.009. PMC 5241253. PMID 27520780.
  6. ↑ Singh TP, Almond CS, Semigran MJ, Piercey G, Gauvreau K (2012). "Risk prediction for early in-hospital mortality following heart transplantation in the United States". Circ Heart Fail. 5 (2): 259–66. doi:10.1161/CIRCHEARTFAILURE.111.965996. PMID 22308287.
  7. ↑ Radovancevic B, Poindexter S, Birovljev S, Velebit V, McAllister HA, Duncan JM; et al. (1990). "Risk factors for development of accelerated coronary artery disease in cardiac transplant recipients". Eur J Cardiothorac Surg. 4 (6): 309–12, discussion 313. doi:10.1016/1010-7940(90)90207-g. PMID 2361019.
  8. ↑ Prendergast TW, Furukawa S, Beyer AJ, Browne BJ, Eisen HJ, Jeevanandam V (1998). "The role of gender in heart transplantation". Ann Thorac Surg. 65 (1): 88–94. doi:10.1016/s0003-4975(97)01105-3. PMID 9456101.
  9. ↑ Montoya, Jose G.; Giraldo, Luis F.; Efron, Bradley; Stinson, Edward B.; Gamberg, Pat; Hunt, Sharon; Giannetti, Nadia; Miller, Joan; Remington, Jack S. (2001). "Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center". Clinical Infectious Diseases. 33 (5): 629–640. doi:10.1086/322733. ISSN 1058-4838.


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