Long-term survival of heart transplant recipients: experience summary of immunosupressive therapy

Objective Summary and analysis the experience of immunosuppressive therapy of 4 recipients who survived over 16 years after heart transplantation. Methods The clinical data of 4 heart transplant recipients in the Second Affiliated Hospital of Harbin Medical University during April 1992 and January 2000 was analyzed retrospectively, which mainly focusing on the treatment experience of immunosuppressive therapy. Four donors were all donation after brain death and donor organs were preserved by improved St. Thomas fluid. The protopathys of recipients were chronic keshan disease (1 case) and dilated cardiomyopathy (3 cases), respectively. The methods of heart transplantation were standard anastomosis (3 cases) and whole-heart (1 case). The immunosuppressive treatment protocol after operation was ciclosporin+ azathioprine+ glucocorticoid and ciclosporin was used for immunosuppressive maintenance therapy. Blood concentration of ciclosporin, periphery white blood count and lymphocyte function were monitored during follow-up. Electrocardiogram, chest X-ray plain film, ultrasonic cardiogram, coronary arteriography, optical coherence tomography (OCT) and endomyocardial biopsy were also did during follow-up. Implosive therapy or immunosuppressive agent replacement therapy was used when rejection occured. Results Three recipients survived and 1 recipient died until June 2016. The survival time of the 3 survivors was 22 years and 4 months, 20 years and 7 months, 16 years and 5 months, respectively. The dead recipient died of multiple organ failure 18 years and 6 months after operation. Four recipients occured rejection 1 to 6 times during 10 years after operation and all recoverd after implosive therapy. The dose of ciclosporin for 3 survivors adjusted to 0.5-1.0 mg·kg-1·d-1 at 10 years after operation. All the recipients showed no coronary artery lesion during 10 years after operation. Three recipients recieved coronary arteriography and OCT in May 2009, and 1 recipient showed plaques infiltration and did not feel any uncomfortable, but the test results of coronary arteriography and OCT of this recipient in May 2015 showed that coronary artery stenosis was found and then stent placement was did. Test results of other two recipients were normal. Conclusions Diagnosis of rejection timely and accurately, adjusting immunosuppressive treatment plan reasonably, individualized immunosuppressive therapy and preventing the complication actively and effectively were helpful to improve long-term survival for heart transplantation recipients. Key words: Heart transplantation; Long-term survival; Rejection; Immunosuppression