Heart Transplantation at Baylor University Medical Center: An 8-Year Experience

Abstract

From March 1986 to December 1993, 137 patients underwent orthotopic heart transplantation at Baylor University Medical Center (BUMC). This communication describes the evolution of cardiothoracic transplantation at BUMC and the results on 122 patients who have had at least 6 months of follow-up since surgery. Transplantation was undertaken for dilated (60), ischemic (58), hypertrophic (3), and restrictive (1) cardiomyopathy. The etiologies of end-stage cardiac disease were atherosclerotic (58), idiopathic (53), viral (1), puerperal (3), valvular disease (6), and amyloid (1). Mean recipient age at the time of transplantation was 51 years (range, 16 to 71 years), while mean donor age was 28 years (range, 10 to 60 years). Ninety-three males and 29 females became heart transplant recipients. Organs were procured distantly for 74% of patients. Mean ischemic time was 163 minutes (range, 51 to 278 minutes); mean follow-up time was 834 days. Endomyocardial biopsies were used extensively to monitor rejection. Immunosuppressive therapy consisted of double- or triple-drug regimens with induction of immunosuppression using Minnesota antilymphocyte globulin, horse antithymocyte globulin, or monoclonal antibody (OKT3). Survival was significantly correlated with 1) induction with antilymphocyte globulin (P < 0.005), 2) donor age (older was worse) (P < 0.005), 3) donor sex (female was worse), and 4) response to vasodilators in candidates with a transpulmonary gradient greater than 10 mm Hg. Survival rates for patients discharged after transplantation were 93% and 76% at 1 year and 5 years, respectively. Early mortality has been eliminated in the past 2 years due to a return to stringent donor and recipient selection criteria. Surviving patients have been rehabilitated successfully: 91% are in New York Heart Association Class I, and 89% have returned to employment or other activities. These gratifying findings reaffirm the value of cardiac transplantation in treating these otherwise desperately ill patients.