| Abstract: | A one year follow-up of the first 29 patients who underwent cardiac transplantation at Stanford University Medical Center from January 1968 to January 1971 is reported. Actuarial survival is 49 per cent at six months, 37 per cent at 12 and 18 months, and 30 per cent at two years. Recipient selection is important for the best long-term results; the ideal candidate is a relatively young patient with recent severe cardiac disability which has been unresponsive to optimal medical and surgical therapy.In our series, three patients died within 72 hours after transplantation secondary to severe fixed pulmonary hypertension. Nine additional patients died in the hospital; in seven of these death was related to unremitting rejection or infection.Thirteen patients were discharged from the hospital, with a 60 per cent actuarial chance of living two years. Evaluation has documented “normal denervated” cardiac function in eight patients one year, and in one of two patients two years after transplantation. Chronic rejection appears to be manifested by cardiac arrhythmias, coronary artery intimal hyperplasia, atherosclerosis and subsequent myocardial infarction.Improved diagnosis and treatment of acute rejection has resulted in yearly improvement in the short-term survival. These patients return to normal activities after hospital discharge and are not limited by their cardiac function. Their long-term survival appears to be limited by coronary arterial changes related to chronic rejection. |
