Long-term outcomes and management of the heart transplant recipient

Abstract

Cardiac transplantation remains the gold standard in the treatment of advanced heart failure. With advances in immunosuppression, long-term outcomes continue to improve despite older and higher risk recipients. The median survival of the adult after heart transplantation is currently 10.7 years. While early graft failure and multiorgan system dysfunction are the most important causes of early mortality, malignancy, rejection, infection, and cardiac allograft vasculopathy contribute to late mortality. Chronic renal dysfunction is common after heart transplantation and occurs in up to 68% of patients by year 10, with 6.2% of patients requiring dialysis and 3.7% undergoing renal transplant. Functional outcomes after heart transplantation remain an area for improvement, with only 26% of patients working at 1-year post-transplantation, and are likely related to the high incidence of depression after cardiac transplantation. Areas of future research include understanding and managing primary graft dysfunction and reducing immunosuppression-related complications.

Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

“…The prognosis of HT has steadily improved with a recent median survival of 12.5 years among adult HT recipients [ 1 ]. A study reported an 82% one-year survival rate and a 69% five-year survival rate after HT [ 2 ]. Kidney disease after HT has become increasingly prevalent as outcomes following HT have improved [ 3 ].…”

Readmission and resource utilization after orthotopic heart transplant versus ventricular assist device in the National Readmissions Database, 2010–2014

“…With the combination of an aging population and increasing burden of ischemic heart disease, the prevalence of end-stage HF continues to rise. 3,4 ✩ Presented at the 13th Annual Academic Surgical Congress.…”

A 1H-NMR approach to myocardial energetics

“…Heart failure is a growing epidemic affecting 26 million people across the world and has a 5 year mortality rate of greater than 40% 11,12 . Currently the only effective therapies are surgical replacement with a donor heart, providing a median survival of 10.6 years 13,14 . Developing a better understanding of the underlying causes of metabolic dysfunction in the failing heart may provide new therapeutic targets that support the energetics of the heart, resulting in improved systolic and diastolic function.…”