Current state in heart transplantation
Yasuda, K.; Ishii, K.; Watanabe, M.; Murashita, T.
Hokkaido Journal of Medical Science 70(2): 221-225
1995
ISSN/ISBN: 0367-6102 PMID: 7774873 Document Number: 440067
The Registry of the International Society for Heart and Lung Transplantation reported that 31,157 transplantations were performed throughout the world until 1993, including 26,704 heart transplantations, 1,567 heart-lung transplantations, 1,943 single lung transplantations and 943 bilateral or double lung transplantations. Heart transplantations were carried out at two hundred fifty-one institutes in the world and more than 3,000 patients received heart transplantations every year. The number of heart transplantations, however, became plateau in 1988 and since 1991 the number of operations rather decreased because of the shortage of donor hearts. Indications for adult heart transplantation include coronary artery disease in 47.2% and cardiomyopathy in 43.5%, representing the most frequently reported indications. Retransplantations represent only 2.3% of the total heart transplantations. The results for heart transplantation reveal that the 1, 3, 5, and 12-year actuarial survival are 80%, 72%, 64% and 40%, respectively. Comparing the data before and after 1982 when cyclopropane was introduced for transplantations, a substantial improvement in actuarial survival is obtained. For instance, 3-year actuarial survival before 1981 was 40% whereas since 1982 3-year actuarial survival is improved up to 75%. However, the patients in the older age (more than 65 years old) and pediatric patients, particularly less than one year old, have a significant reduction in outcome compared with younger adult patients and the outcome of heart retransplantation was still poor. Because of the shortage of donor heart quite a large number of patients develop hemodynamic deteriorations before transplantation and mechanical assist device is one of strategies to treat these patients as bridge to heart transplantation.