Early Results of Heart Transplantaion: A Review of 20 Patients

Park, Chong Bin; Song, Hyun; Song, Meong Gun; Kim, Jae Joong; Lee, Jay Won; Seo, Dong Man; Sohn, Kwang Hyun

Abstract

Heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in humans was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 50 cases have been performed in Korea. A total of 20 patients underwent orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The purpose of this study is to evaluate the early results and the follow-up course of 20 cases of heart transplantation done in Asan Medical Center. The average age of 20 patients was 39.9+/-11.8 years old(20~58). The mean follow-up duration was 14.4+/-11.2 months(1~41). All patients are alive till now. The blood type was identical in 14 and compatible in 6 patients. The original heart disease was dilated cardiomyopathy in 16, valvular heart disease in 2, ischemic cardiomyopathy in 1, and giant cell myocarditis in 1 patient. HLA cross matching for recipient and donor was done in 18 cases and the results were negative for T-cell and B-cell in 16 patients, positive for warm B-cell in 2 patients. Among 6 loci of A, B, and DR, one locus was matched in 8 cases, 2 loci in 5 cases, and 3 loci matched in 1 case. The number of acute allograft rejection averaged 2.8+/-0.5(0~6) per case and the number of acute allograft rejection requiring treatment averaged 1.0+/-0.9(1~3) per case. The time interval from operation to the first acute rejection requiring treatment was 35.5+/-20.4 days(5~60). Acute humoral rejection was suspected strongly in 1 case and was successfully treated. The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 17.5+/-6.8(9~32)% to 58.9+/-2.0(55~62)% after heart transplantation. Temporary pacing was needed in 5 patients over 24 hours but normal sinus rhythm appeared within 7 days in all cases. One patient has been taken permanent pacemaker implantation due to complete AV block appearing 140 days after heart transplantaion. One patient had cyclosporine-associated neurotoxicity during the immediate postoperative period and was recovered after 27 hours. The heart transplantation of Asan Medical Center is on a developing stage but the early result is comparable to that of well established centers in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in patients with terminal heart failure.