Cardiac transplantation: Australian results

Between February 1984 and November 1989, 188 orthotopic cardiac transplants were performed at St Vincent’s Hospital, Sydney, in 183 patients. Five patients required retransplantation. All patients were in New York Heart Association Functional Class III to IV before transplantation. Thirty-four of these patients were female and 149 male. Recipient diagnosis in 98 patients was primary cardiomyopathy, while 71 had ischemic heart disease, 13 had valvular heart disease, and 1 patient had congenital heart disease. Three different immunosuppressive protocols have been used: cyclosporin A (CsA) + prednisolone (P), CsA + azathioprine (Aza) + P, and CsA + Aza. Antithymocyte globulin (ATG) was administered for a 7-day period in all groups. Subsequently, there was a prospective trial comparing OKT3 to ATG for prophylactic immunosuppression - there was one death in the OKT3 group due to rejection. There have been 28 deaths overall. From our experience, a combination of CsA and Aza, with or without the addition of prednisolone, has improved our actuarial 5-year survival, which has risen from 68% (CsA + P), to 82.7% (CsA + Aza + P) or 90.48% (CsA + Aza). Our experience demonstrates that with orthotopic heart tranplantation, 1-year survival in excess of 90% and a 5-year survival of 85% can be achieved in patients ranging in age from 9 years to 65 years. The majority of patients return to a productive lifestyle, with 75% returning to employment, home duties, or study.