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J Thorac Cardiovasc Surg 1999;117:939-951
© 1999 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

THIRTY YEARS OF CARDIAC TRANSPLANTATION AT STANFORD UNIVERSITY

From the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, Calif.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested Aug 13, 1998. Revisions received Jan 7, 1999. Accepted for publication Jan 27, 1999. Address for reprints: Robert C. Robbins, MD, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5407.

Background: The experience with 30 years of cardiac transplantation at Stanford University Medical Center was reviewed. A total of 954 transplants were performed in 885 patients. Patients were divided into 3 groups based on immunosuppression received: group I, no cyclosporine (INN: ciclosporin) (n = 201) (January 1968–November 1980); group II, cyclosporine (n = 248) (December 1980–June 1987); and group III, cyclosporine + OKT3 (n = 436) (July 1987–March 1998).
Results:The 1-, 5-, and 10-year actuarial survivals were 68%, 41%, and 24% (group I); 80%, 57%, and 37% (group II); and 85%, 68%, and 46% (group III) (I vs II, P < .01; I vs III, P < .005; and II vs III, P < .005). The 1-, 5-, and 10-year actuarial death rates from rejection were 8%, 12%, and 14% (group I); 5%, 7%, and 7% (group II); and 2%, 5%, and 5% (group III) (I vs II, P = not significant; I vs III, P < .005; and II vs III, P < .005). The 1-, 5-, and 10-year actuarial death rates from infection were 25%, 43%, and 50% (group I); 8%, 17%, and 29% (group II); and 6%, 11%, and 16% (group III) (I vs II, P < .005; I vs III, P < .005; and II vs III, P < .05). The 1-, 5-, and 10-year actuarial death rates from graft coronary artery disease were 0%, 5%, and 13% (group I); 0%, 12%, and 19% (group II); and 1%, 6%, and 9% (group III) (I vs II, P < .01; I vs III, P < .005; and II vs III, P = not significant). There have been 69 retransplants in 67 patients with 1-, 5-, and 10-year actuarial survivals of 49%, 27%, and 15%, respectively.
Conclusions: The evolution of 3 decades of experience with cardiac transplantation has resulted in improved overall survival. The incidence of rejection and of death from infection and graft coronary artery disease have decreased over time, primarily as a result of improvements in immunosuppression and in the prevention and treatment of infection. Continued advances in perioperative management and the development of more specific, less toxic immunosuppressive agents could further refine this initial experience and improve the survival and quality of life of patients after cardiac transplantation.

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