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Life Expectancy after Transplant
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Life Expectancy after Transplant


  My husband has just completed heart transplant evaluation, and we are
  waiting to hear the medical review board's decision on his case.  His EF
  is 12-15%, he has one leaky valve, has premature ventricular contractions,
  his left main artery has a 30% blockage, and his heart is grossly enlarged.  
  He was implanted with an AICD 6 weeks ago, and has been told that he has
  congestive heart failure, Class III, caused by idiopathic dilated
  cardiomyopathy.
  We have heard that the longest a transplant patient may expect to live, after
  transplantation, is 10 years.  I would like to know if this is true, and also
  what the mortality rate is in the first year, second year, etc. after transplant.
  Thank you for your response.
  Karen
Dear Karen,
  Thank you for your question. It is true that survival is  limited (due to immunosupressent medication and transplant coronary artery disease) following transplant but it is still much better than the pre-transplant survival.  10 years is an arbitrary number and some will live much longer than this and some shorter.  Percentages are good only for population studies.  For an individual patient it is either 0 or 100%.  Only God knows when we will die and until that day my philosophy is to keep a positive attitude and to make the most of every day.  Below is some general information concerning heart transplant.
().
  General Overview
  Cardiac transplantation is a remarkable way to treat select patients with severe hear failure. Indeed, few things are more
impressive than observing dramatic functional improvement of an individual with advanced heart failure or cardiogenic shock
after a successful heart transplant. For many patients, transplantation of the heart is the only treatment that can markedly impact
an extraordinarily high mortality. Time has proven that this operation, and, in some circumstances, mechanical ventricular assist
device implantation, is effective in diminishing morbidity and premature mortality in select patients.
  The United Network of Organ Sharing (UNOS) database contains information on over 100,000 organ transplant procedures.
Cardiac transplantation accounts for 14% (14,374) of these operations. Kidney transplantation accounts for 52% and liver
transplantation represents 19% of organ transplants done between 1988 and 1994 in the United States. Though there has been
some increase in the number of heart transplants performed since 1988, a plateau has been reached. It appears that we will
only be able to perform between 2000 and 2500 heart transplants yearly due to the low number of organ donors.
  Historical Perspective
  Few modern surgical procedures caused as much excitement, public interest, controversy, and dilemma as human cardiac
transplantation. Though there are parallels between the development of organ transplantation in general, and cardiac
transplantation specifically, several important distinctions can be noted. For example, the history of cardiac transplantation and
mechanical assist devices development is quite intermingled, having obvious mutual interdependence. Interesting, the concept of
replacing a diseased heart to cure ailments thought cardiac in origin, is not new. Reference though abstract, to receiving a "new
heart" can be found in the Old Testament and dated to the sixth century BC where the prophet Ezekiel is said to proclaim "a
new heart also I will give you, and a new spirit will I put within you; and I will take away the stony heart out of your flesh and I
will five you a heart of flesh".
  Interestingly, in 1964, the first well-documented patient to undergo cardiac transplant received a primate heart rather than a
human allograft. Dr James Hardy at University Hospital in Jackson, Mississippi, transplanted the heart of a chimpanzee into a
68-year-old gentleman with diabetes, severe coronary artery disease, a diffuse peripheral vascular disease. The gentleman had
developed cardiogenic shock due to an unstable ischemic syndrome and emergency coronary bypass grafting surgery was
attempted. After failing to wean the patient from cardiopulmonary bypass, cardiac transplantation, a procedure that had been
contemplated by Dr. Hardy for some time was attempted with the primate's heart. The graft was implanted satisfactorily, with
the patient partially coming off cardiopulmonary bypass. However, the xenoheart was not large enough to maintain independent
circulation for a significant period of time.
  Investigators such as Drs. Norman Shumway of Stanford University and Richard Lower of the Medical College of Virginia
were poised to perform human-to-human cardiac transplants when Christiaan Barnard of Capetown, South Africa, performed
the first one on December 3, 1967. The patient survived 18 days, dying of septicemia. This transplant was done shortly after
Barnard had spent time observing work in progress at the University of Minnesota and Stanford. Not only did this procedure
shock the public, it stirred resentment in the medical and surgical professional communities and fueled bitter discussion
regarding definition of an appropriate heart "donor" particularly with respect to the concept of brain death
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