ABSTRACT
At La Pitié Hospital, 1,184 patients underwent cardiac transplantation for end-stage cardiac disease (1,122 orthotopic and 62 heterotopic) between April 1968-November 1998. Since April 1986, 140 patients have been supported using several different mechanical assist devices as a bridge to transplantation. Twenty-four retransplantations (2.2%) were performed for primary graft failure in 4 (17%), refractory acute rejection in 7(29%), coronary graft disease in 11 (46%) and others in 2 (8%) patients. In a case-control study, retransplanted patients were matched with first transplant patients and survival rates at one and 5 years were 59.4% and 38.8% compared with survival rates for retransplanted patients of 45.4% and 31.2%, respectively. Seventy-four patients survived more than 10 years (61 males, 13 females). Mortality did not increase after 10 years. Unfortunately many suffered complications: 77% had hypertension, hypercholesterolemia (22%), hyperuricemia (41%), osteoporosis (11%), osteonecrosis (5%) and diabetes (7%). Renal function remains one of the main problems; 16% had a creatinine > 180 mumol/L and patients are on chronic dialysis.
Subject(s)
Heart Transplantation/statistics & numerical data , Actuarial Analysis , Catholicism , Female , Graft Survival , Heart Transplantation/mortality , Heart Transplantation/physiology , Hospitals, Religious/statistics & numerical data , Humans , Male , Paris , Postoperative Complications/epidemiology , Reoperation , Retrospective Studies , Survival RateABSTRACT
The lack of donor organs in France has led to a decrease in the number of cardiac transplantations (636 in 1990. 429 in 1994), despite the fact that the number of indications remains high. The reasons for this inadequation are multiple, but family refusal remains the major cause (65% of cases of non-donation). Efforts should continue to try and reverse this attitude to make this unequaled treatment available. The difficulties should in no case influence the indications of transplantations.
