Columbia University Medical Center

Risk Factors In Long-Term Survival Of Heart Transplantation

New York, NY, February 13, 2001– Researchers at Columbia University College of Physicians & Surgeons report that 40 percent of heart transplant recipients live 10 or more years, but patients who have coronary artery disease before heart transplantation have a less favorable long-term outlook. The study suggests that patients who monitor and treat their underlying coronary artery disease after surgery may improve the long-term survival.
The retrospective study, headed by principal investigator Niloo M. Edwards, M.D., assistant professor of surgery and the director of cardiac transplantation at Columbia-Presbyterian Medical Center, was reported in the January issue of the Journal of the American College of Cardiology. The study looked at pre-transplant factors affecting long-term survival (more than 10 years of survival) after cardiac transplantation, including recipient and donor characteristics, quality of the donor heart match, type of immunosuppressive therapy, and pre-existing indications for heart disease.
“Patients who were transplanted for coronary artery disease do not do as well in the long term as other patients because they still have the same risk factors as before surgery, such as hypertension, hypercholesterolemia, smoking, and diabetes,” says lead author Ranjit John, M.D., of the Department of Surgery at Columbia-Presbyterian. “Therefore you need to target treatments to the underlying risk factors for arteriosclerosis.”
Coronary artery disease is caused by narrowed blood vessels that supply blood to the heart. When less blood and oxygen reach the heart, a heart attack and other related heart problems can result.
The retrospective study looked at 195 patients who underwent heart transplantation at Columbia-Presbyterian for the treatment of end-stage heart disease between 1983 and 1988. Of the 195 patients, 39 percent survived for more than 10 years. While only 22 percent of the long-term survivors developed coronary artery disease in the transplanted heart, patients with a pre-transplant diagnosis of coronary artery disease were at the greatest risk for developing coronary artery disease. Patients with underlying coronary artery disease also had a poorer prognosis (27 percent) for long-term survival than patients with other kinds of heart problems (43 percent).
This study reinforces the need to monitor and prevent known risk factors for coronary artery disease after heart transplantation. Specifically, the authors recommend the routine postoperative use of cholesterol-lowering agents and calcium channel blockers in heart transplant recipients. The study also confirms the effectiveness of heart transplantation in long-term survival and quality of life. Given the current trends in transplantation and medical management of heart disease, the authors anticipate that the number of patients who survive 10 or more years will continue to increase.
Other investigators include Hiranya A. Rajasinghe, M.D., Silviu Itsecu, M.D., Sanjeev Suratwalla, B.S., Katherine Lietz, M.D., Alan D. Weinberg, M.S., Alfred Kocher, M.D., Donna M. Mancini, M.D., F.A.C.C., Ronald E. Drusin, M.D., F.A.C.C., Mehmet C. Oz, M.D., Craig R. Smith, M.D., F.A.C.C., and Eric A. Rose, M.D., F.A.C.C.

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