Heart transplantation. Candidate evaluation and predictors of outcome in long-term follow-up

Abstract

The shortage of donor hearts emphasizes the importance of an optimal selection among candidates for heart transplantation. The aim of this study was to identify patients with severe heart failure for whom a heart transplantation could be postponed or avoided and to find predictors for complications associated with a reduced survival after heart transplantation.Methods: During evaluation of candidates for heart transplantation, improvement in therapy was tested and alternative treatments were considered. Maximal exercise tolerance test, Doppler-echocardiography, right heart catheterization, coronary angiography, and measurement of glomerular filtration rate were performed. After heart transplantation, the patients were monitored continuously regarding cyclosporine-A concentration and development of complications, during the first year with endomyocardial biopsies, and annually with right heart catheterization, coronary angiography and glomerular filtration rate.Results and conclusions: Of the patients admitted for heart transplantation evaluation, 15% improved on intensified therapy and heart transplantation could be postponed. A pre-operative pulmonary vascular resistance >3 Wood Units, but reversible, did not interfere with the outcome after heart transplantation. Ischaemic heart disease as aetiology of heart failure and frequent cellular rejections were found to be independently predictive of the development of coronary artery disease after heart transplantation. Among our study patients, 20% developed graft coronary artery disease under 9 years of follow-up. Recipient age was an independent predictor of the post-operative evolution of renal function and the recipient age combined with the glomerular filtration rate at one year after transplantation, predicted the development of post-operative severe renal dysfunction (glomerular filtration rate £20 ml/min/1.73 m2), which was found in 20% of our study patients during 9 years following heart transplantation.