An experience of 17 adult cardiac transplantations

Oh, Byung Hee; Kang, Hyun Jae; Chung, Woo Young; Chae, In Ho; Kim, Hyo Soo; Sohn, Dae Won; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Sik; Seo, Jung Don; Lee, Young Woo; Seo, Jeong Wook; Kim, Ki Bong; Rho, Joon Ryang

Abstract

BACKGROUND: Cardiac transplantation has been established as a treatment of choice for patients with end- stage heart failure. However, the experiences of cardiac transplantation are still limited in Korea.
METHODS
Seventeen adult cardiac transplantations (13 males and 4 females) were performed in Seoul National University Hospital since March 1994. Clinical outcome & course, acute rejection, and complications among transplanted patients were reviewed.
RESULTS
Underlying cardiac conditions leading to cardiac transplantation were dilated cardiomyopathy in 9, valvular heart disease with severe LV dysfunction after prosthetic valve replacement in 3, restrictive cardiomyopathy in 2, ischemic cardiomyopathy in 1, intractable ventricular tachyarrhythmia in 1 and hypertrophic cardiomyopathy with severe LV dysfunction in 1 patient. Ages of recipients were between 22 and 54 (median:38). Mean follow up duration was 27 months (1-45 months). The frequencies of rejection decreased with time and were similar to those of previous reports: 1.23 episodes of rejections per patients during first 3months after transplantation, 0.25 during second 3months, 0.17 and 0.08 during third and fourth 3 months. Infectious complications developed in 21.4% of patients during the first year after transplantation and infectious agents were Cytomegalovirus (CMV), gram negative bacteria, and Candida. One-year survival rate of recipients was 81.9%. Systemic CMV infection in 1, aortic rupture in 1, and sudden death in 1 patient were the causes of mortality, all of which developed during early post-transplantation period.
CONCLUSION
Cardiac transplantation seems to be a reasonable therapeutic regimen for patient with end stage heart failure even in this country with limited experience; however, close attention and management against acute rejection and infectious complications, especially during the early post-transplantation period, are critical for long term survival.