Morbidity, functional status, and immunosuppressive therapy after heart transplantation: an analysis of the joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry

W M Brann, L E Bennett, B M Keck, J D Hosenpud
Journal of Heart and Lung Transplantation 1998, 17 (4): 374-82

BACKGROUND: The morbidity and mortality studies on heart transplantation to date have come from single-center or multicenter studies that often have required collection of data over periods of time greater than a year. Data are now available from the International Society for Heart and Lung Transplantation/United Network for Organ Sharing (ISHLT/UNOS) Thoracic Registry from all centers in the United States performing heart transplantation, which allows analysis of morbidity and mortality rates on an annual basis.

METHODS: All transplantation centers in the United States are now required to submit registration (at the time of transplantation) and 1-year follow-up clinical data on all heart transplant recipients to the ISHLT/UNOS Thoracic Registry. Data forms were submitted to the Registry regarding pretransplantation diagnoses, causes of death, rehospitalization, functional and work status at 1 year, immunosuppressive therapy, and the development of complications such as hypertension, hyperlipidemia, renal insufficiency, diabetes, and malignancy. This study is an analysis of this database for the period of April 1, 1994, through March 31, 1995, examining specifically morbidity, functional status, and other clinical events occurring during the period after the initial hospitalization and up to the first-year follow-up. The study cohort consisted of the 1853 patients who survived the initial hospitalization and for whom matching registration and 1-year follow-up forms were available.

RESULTS: Rehospitalization during the first year after the initial admission was required by more than 40% of survivors, and at least one third of these required admission to the intensive care unit. Infection and rejection were the most common reasons for rehospitalization, each accounting for about 20%. Complications during the first year occurring in 10% or more of survivors included hypertension, diabetes, renal dysfunction, and hyperlipidemia. Less common complications included symptomatic bone disease, chronic liver disease, cataracts, stroke, and malignancy. Allograft function was excellent among survivors at 1 year, with a mean ejection fraction of 57.4% and less than 7% of patients requiring pacemaker therapy or having development of coronary artery disease. Eighty-three percent of survivors reported no functional limitations, but only 27% were working full-time. Eighty-nine percent of survivors were receiving prednisone at their 1-year follow-up.

CONCLUSION: Clinical data are now available from the ISHLT/UNOS Thoracic Registry on the basis of the initial registration and 1-year follow-up of all patients undergoing heart transplantation in the United States. Analysis of these data from April 1, 1994, through March 31, 1995, demonstrates that the first year after the initial hospitalization for heart transplantation is a period of significant morbidity and frequent rehospitalization but excellent survival. In spite of a high level of functional capacity at 1-year follow-up, only a minority of patients return to work. The ISHLT/UNOS Thoracic Registry can now serve as a valid source of data for future analysis of trends in heart transplantation in the United States.

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