Long-term survival (>20 years) following heart transplantation.
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Only a few papers with patients surviving more than 15 years after heart transplantation have been reported. Herein we report the characteristics of patients transplanted between 1984 and 1989 who are long-term survivors (>20 years). Survival after transplant, recipient and donor age and aetiology of heart failure were also compared with patients transplanted in the decades 1990-1999 and 2000-2009.Our Heart Transplant Program Database and medical records of all cardiac transplants performed in our centre from July 1984 to 1989 were reviewed. Primary endpoint of the study was the long-term survival and secondary end points were the incidence of transplant-related complications over time.Forty-five transplants were performed in 1984-1989, 41 patients were male, median age was 46 years (IQR: 39-55), median donor age was 24 years (19-29) and mean graft ischemic time was 134±64 minutes. The actuarial survival of this cohort was 77.8%, 64.4%, 48.9%, 35.6% and 24.2% at 1, 5, 10, 15 and 20 years, respectively. Univariate Cox regression analysis revealed the female gender, the graft ischemic time, the recipient-donor gender mismatch, a diagnosis of diabetes and the number of acute rejection episodes during the first year post-transplant as significant risk factors adversely affecting long-term survival. Cardiac allograft vasculopathy is the main cause of death. The mean recipient and donor age and the graft ischemic time have progressively increased over time but survival has not changed.The long-term outcome of heart transplantation is noteworthy. The main limiting factor for survival is the allograft vasculopathy. Considering the tremendous advances in the immunosuppressive therapy and in the understanding of CAV pathophisyology, we can hope for even better results in the next years.Keywords:
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We aimed to compare post-transplantation morbidity and survival among heart transplant recipients with and without diabetes mellitus. A retrospective review of 141 adult patients submitted to heart transplantation from November 2003 to June 2009 (with a minimum follow-up of one year) was undertaken. The patients were divided into two groups: those with (29%) and those without (71%) pre-transplantation diabetes. Those with diabetes were older (57.6 ± 6.1 vs. 52.3 ± 11.1 years; P=0.020) and had lower creatinine clearance (53.6 ± 15.1 vs. 63.7 ± 22.1; P=0.029). Nine patients died in hospital (6.4%; P=non-significant). No significant differences in lipid profiles (diabetes vs. no diabetes) existed before transplantation or at one year afterwards. Patients with diabetes showed a significant deterioration in their one-year lipid profile (158 ± 43 vs.192 ± 38 mg/dl; P=0.001), although one-year fasting diabetic was lower than before (178 ± 80 vs. 138 ± 45 mg/dl; P=0.016). During the first year, 17 (17%) patients previously free of diabetes developed new-onset diabetes. No significant differences were seen in rejection at one year (14% vs. 20%), infection (31% vs. 33%), new-onset renal dysfunction (8% vs. 14%) or mortality (17% vs. 7%). One-year survival was not significantly different (83% vs. 94%), but there was a significant decrease in the survival of individuals with diabetes at three years (73% vs. 91%; P=0.020). No significant difference was found in one-year survival or in terms of higher morbidity in the heart transplant patients with diabetes, but a longer follow-up showed a significant decrease in survival. Nonetheless, the patients with diabetes benefited significantly from transplantation and should not be excluded from it.
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Objective To summarize and analyze the primary data from China Heart Transplant Registry in 2013 in order to explore the current status of heart transplantation in Chink Method Seventeen transplant centers have conducted 231 cases of heart transplantation in the year 2013.We analyzed the preoperative risk factors which impacted the survival of heart transplant by using univariate and multivariate logistic regression analysis.And long-term survival of the 398 heart from Beijing Fu Wai Hospital,who were followed up from June 2004 to December 2013 (follow-up rate was 100 ％) was calculated by the Kaplan-Meier method.The risk factors for long-term survival of heart transplant were calculated by the COX survival analysis methods.Result The mean hospital stay of the 231 was 24 days.There were 25 cases who died in hospital,and the total mortality was 10.8 ％ (25/231),while the average in-hospital mortality was 2.2 ％ in the three largest centers.By using the univariate and multivariate logistic regression analysis,we found that recipients positive PRA was the only preoperative risk factor which impacted the in-hospital mortality.(OR=12.435,95％ CI 1.369～ 112.938,P =0.025).The median follow-up time of the 398 heart transplant from Beijing Fu Wai Hospital was 1383 days,and the 1-,3-,5-and 7-year survival rate was 94.7％,91.6％,88.0％ and 82.6％ respectively.The univariate and multivariate COX regression analysis revealed that preoperative primary diseases (coronary heart disease vs.cardiomyopathy,P ＜ 0.01),the history of chronic obstructive pulmonary disease (P ＜ 0.01),the preoperative total bilirubin level (P＜0.05) and serum creatinine level (P＜ 0.01) were risk factors affecting long-term postoperative survival.Conclusion In China the number of heart transplants has increased in 2013.The survival rate of is high in large heart transplant centers.The integrity of registration data needs to be further improved in some centers.
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China; Heart transplantation; Survival
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Objective To investigate the incidence and features of ocular complications of patients with diabetes mellitus(DM).Methods The examination of eyes and other clinical materials of 328 patients with DM were analyzed.The ocular complications were classified and analyzed finally.Results The total rate of ocular complications was 76.82%,in which the diabetic retinopathy(DR) was the most common one and accounted for 60.37%.The longer the course of disease was,the higher the incidence of ocular complications was.Conclusions The ocular complications should become more severe according with the development of DM.DR is the main one among the multiple complications.
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Objective To investigate the influencing factors on survival in elderly patients with chronic heart failure.Methods A total of 298 patients with chronic heart failure were enrolled in this study and 20 exposure factors were analyzed by univariate and multivariate COX model.Results Univariate analysis showed that age,multiple etiologies, NYHA classification,NT-proBNP,LVEF,ACE1 and beta-blocker using have significant influence on prognosis of patients with heart failure(RR was 3.007,2.354,2.283,4.385,1.381,0.721 and 0.506,respectively,and 95%CI 1.589- 5.675,1.1784.704,1.534-4.617,1.900-10.121,1.573-3.212,0.562-0.837 and 0.283-0.905,respectively,all P0.05).Multivariate analysis showed that age,multiple etiologies,NT-proBNP,beta blockers using have significant independent influence on survival of patients with heart failure(RR was 2.683,2.953,2.469 and 0.628 respectively, with 95%CI 1.344-5.355,1.456-5.987,1.032-5.912 and 0.463-0.958,respectively,all P0.05 ).Conclusions Age,etiology,NT-proBNP,beta blockers using are independent influencing factors of survival in elderly patients with chronic heart failure.
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Journal Article Incidence, aetiology, diagnosis, and prognosis of closed abdominal injuries, A study of 265 consecutive cases Get access David H Wilson David H Wilson Research Assistant The Casualty Department of the General Infirmary at Leeds Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 50, Issue 222, January 1963, Pages 381–389, https://doi.org/10.1002/bjs.18005022206 Published: 06 December 2005
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