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PubMed1996

National Transplantation Pregnancy Registry: report on outcomes in cyclosporine-treated female kidney transplant recipients with an interval from transplant to pregnancy of greater than five years.

Successful renal transplantation enables previously infertile females to conceive and carry a pregnancy. Much of the reported data on posttransplantation pregnancy accrued before the advent of cyclosporine, when steroids and azathioprine were the mainstays of maintenance immunosuppression. One factor affecting pregnancy outcome in kidney recipients is the length of time from transplantation to conception or transplant interval. It has been recommended that patients wait at least 2 years posttransplantation to conceive, as transplant intervals of shorter duration have had less favorable outcomes. Some have suggested that extended transplant intervals (> 5 years) paradoxically result in adverse outcomes. We have extracted data on cyclosporine-treated recipients with transplant intervals longer than 5 years from the National Transplantation Pregnancy Registry, and report 17 pregnancies from 15 recipients (transplant interval, 5.9 +/- 0.9 years). There were 13 live births (76.5%) and four spontaneous abortions (23.5%). The mean gestational age was 37.7 +/- 2.04 weeks and mean birth weight was 2,753 +/- 679 g. Prematurity occurred in 30.8%, low birth weight in 15.4%, very low birth weight in 7.7%, and neonatal complications in 15.4%. There were no maternal or neonatal deaths. The mean serum creatinine before pregnancy was 1.31 mg/dL, and there was no significant change during or after pregnancy. There were no rejections during or up to 3 months postpartum. Graft survival at 2 years was 100%. We conclude that most pregnancy outcomes in cyclosporine-treated recipients with transplant intervals greater than 5 years are favorable for the newborn, recipient, and graft.

Analysis of Variance↗
PubMed1999

Can low volume liver transplant centers be successful? The Regional Transplant Center of Willis-Knighton & Louisiana State University Medical Center. The first 120 liver transplants.

The development of orthotopic liver transplantation represents this century's most significant advance in the management of liver disease. In the 1980s the vast majority of liver transplants were performed at several large centers; however, in this decade, improvements in techniques and success rates have allowed live transplantation to expand to regional centers across the country, particularly in the southeast. This proliferation of regional centers and the widening disparity between organ availability and numbers of recipients have created tremendous controversy at the national level regarding the allocation scheme used to distribute livers to recipients. The large programs today are advocating change to a national waiting list which would eliminate local priority and jeopardize the existence of smaller regional centers. Furthermore, the large programs favor establishing a limited number of megacenters where all liver transplants would take place, arguing that low volume centers cannot perform liver transplants with acceptable complication and survival rates. At the Regional Transplant Center of Willis-Knighton Hospital and Louisiana State University Medical Center in Shreveport (WK/LSUMC) we performed 122 liver transplants between July 1, 1991 and December 31, 1997. The purpose of this study was to examine our complication and survival rates and compare them to national averages. The actuarial graft survival at 1, 2, and 3 years in this series compared to the national average respectively was 76% and 70%, 66% and 66%, 62% and 62%. The actuarial patient survival (WK/LSUMC vs National) at 1, 2, and 3 years was 80% and 80%, 75% and 75%, 70% and 74%. The rate of retransplantation was 8% with a national average of 10% to 20%. Our rate of graft primary non-function was 5% with the national average being 2% to 10%. The rate of vascular thrombosis of the graft in this series was 2% with a national rate of 5%. The differences in these results were not statistically significant (P < .05). Low volume transplant centers can perform liver transplant successfully, allowing the regionalization of the treatment of choice for end-stage liver disease.

Actuarial Analysis↗
PubMed2006

Long-term outcome of patients given transplants of mobilized blood or bone marrow: A report from the International Bone Marrow Transplant Registry and the European Group for Blood and Marrow Transplantation.

We previously compared outcomes after allogeneic peripheral-blood stem cell (PBSC) and bone marrow (BM) transplantation in 706 patients with leukemia. We obtained long-term follow up on 413 of 491 patients who were alive at the time of the initial report: 141 PBSC and 272 BM recipients. Chronic graft-versus-host disease (GVHD) was more frequent after PBSC compared to BM transplantation (RR 1.65, P < .001) yet relapse rates were similar in both groups. Leukemia-free survival rates were higher after PBSC than BM transplantation for patients with advanced chronic myeloid leukemia (33% versus 25%) but lower for those in first chronic phase (41% versus 61%) due to higher rates of late transplant-related mortality. Leukemia-free survival was similar after PBSC and BM transplantation for acute leukemia. These data represent the early experience with PBSC grafts. Long-term outcomes in recipients of more recent transplants are required to better evaluate the role of PBSC grafts relative to BM transplantation.

Bone Marrow Transplantation↗
PubMed2004

Reduced incidence of hypertension after heterotopic cardiac transplantation compared with orthotopic cardiac transplantation: evidence that excision of the native heart contributes to post-transplant hypertension.

OBJECTIVES: This study was designed to test the hypothesis that heterotopic heart transplant (HHT) patients have lower blood pressure than orthotopic cardiac transplant (OCT) patients because their native heart is involved in blood pressure homeostasis. BACKGROUND: Hypertension occurs more frequently after OCT than after liver or lung transplantation, suggesting that transplantation of the heart itself contributes to post-transplant hypertension. METHODS: Blood pressure and related measurements in 233 OCT and 38 HHT patients were studied retrospectively post-transplant. RESULTS: Systolic blood pressure (SBP) was persistently lower among HHT patients (means 121 vs. 137, 126 vs. 137, 125 vs. 139, and 128 vs. 143 mm Hg at month 3 and years 1, 3, and 5 respectively, p < 0.005). Left ventricular and aortic systolic pressures were also lower (130 vs. 143 mm Hg, p = 0.01 and 129 vs. 142 mm Hg, p = 0.01). Multivariable analysis with age, gender, body mass index, creatinine, steroids, cyclosporine, use of antihypertensive medication, donor left ventricular ejection fraction, donor weight, and type of transplant as covariables showed HHT to be independently associated with a lower SBP at each time point (beta-coefficients -16.2, -12.1, -13.3, and -14.2 mm Hg, p < 0.01). The adjusted hazard ratio for the development of systolic hypertension among HHT compared with OCT patients was 0.59 (95% confidence interval 0.39 to 0.91, p = 0.017). CONCLUSIONS: Heterotopic heart transplant patients had lower SBP than OCT patients, consistent with the hypothesis that the native heart continues to contribute to blood pressure homeostasis.

Adolescent↗
PubMed2002

European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease after renal transplantation.

GUIDELINES: A. Post-transplant cardiovascular disease is very common, an important cause of morbidity and the first cause of mortality in renal transplant recipients. Therefore, detection and early treatment of post-transplant cardiovascular disease are mandatory. B. Specific risk factors for developing post-transplant cardiovascular disease include pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive treatment. These factors should be targeted for intervention. C. Pre-transplant cardiovascular disease is a major risk factor for post-transplant cardiovascular disease. Therefore, prior to transplantation, it is mandatory to detect and treat symptomatic coronary artery disease, heart failure due to valvular failure or cardiomyopathy, and pericardial constriction. This policy should also be followed in asymptomatic diabetic patients.

Cardiovascular Diseases↗
PubMed1997

Commercially motivated renal transplantation: results in 540 patients transplanted in India. The Living Non-Related Renal Transplant Study Group.

Commercial renal transplantation is widely condemned on moral and ethical grounds. Moreover, previous studies involving small numbers of patients, mostly from tertiary care centers, have reported poor patient and graft survival. The Living Non-Related Renal Transplant Study Group was established to determine the overall results and complications in a large number of patients who received this type of transplantation in India. In this study we retrospectively collected data from 22 centers on 540 patients who had received commercial renal transplantation (CRT) in India between 1978 and 1993. The data collected included demographic characteristics of patients, the primary renal disease, dialysis and pretransplant data, immunosuppressive regimen, rejection episodes, post-transplant data, as well as patient and graft outcomes. Results were compared with those of 75 recipients of emotionally related renal transplantation (ERT) performed in two participating institutions in the Middle East. Among the 540 patients, 7.5% were younger than 20 yr of age and 14.2% were 50 yr of age or older. After adjusting for several variables, the 1-, 3-, and 5-yr patient survival rates in the CRT were 97, 94, and 92%, and in the ERT 95, 91, and 91% respectively (p = 0.4921). The corresponding rates for graft survival were 90, 81, and 72%, and 90, 86, and 83%, respectively (p = 0.5336). There was a higher incidence of human immune deficiency virus (HIV) infection (4.6% vs. 0% p = 0.053), and hepatitis B virus (HbsAg) infection rate (8.1% vs. 1.4% p = 0.03) in CRT. In conclusion, patient and graft survival rates in recipients of commercial renal transplantation are similar to those in recipients of emotionally related transplantation done in our institutions. However, the incidence of serious infections with HIV and HbsAg is significantly higher.

Adult↗
PubMed1998

Liver transplantation in familial amyloidotic polyneuropathy (FAP). A comparative study of transplanted and non-transplanted patient's survival.

The purpose of the present study was to evaluate the impact of liver transplantation on familial amyloidotic polyneuropathy (FAP met-30) patients' survival. Forty-five FAP patients were involved in the study; 15 non-transplanted FAP patients and 30 liver-transplanted patients. All patients' records were scrutinised for information on disease duration. Preoperative nutritional status was evaluated in all patients. No difference in survival was observed for transplanted patients overall compared to historical controls. However, for cases in good nutritional status, an increased survival can be expected as a significantly increased mortality rate for malnourished patients was observed (P < 0.05). Increased survival has so far not been found for transplanted FAP patients. However, none of the transplanted cases has yet reached the expected survival time for nontransplanted FAP control patients. which is 14 years. A high fatality rate of malnourished patients transplanted late in the course of the disease contributed significantly to the mortality among transplanted patients.

Adult↗
PubMed2006

Reversible pulmonary hypertension in heart transplant candidates: to transplant or not to transplant.

BACKGROUND: Pulmonary hypertension (PHT), defined as a pulmonary vascular resistance (PVR) greater than 2.5 Wood units [WU] and(or) transpulmonary gradient (TPG) greater than 12 mm Hg, is a risk factor for mortality in cardiac transplantation due to elevated postoperative right heart failure. Orthotopic heart transplantation is possible if PVR could be reversed below 2.5 WU and TPG below 12 mm Hg. We show the Muenster experience from the last 10 years. METHODS: From April 1996 to December 2005 all cardiac transplant recipients separated into patients with and without PHT were included. All patients with PHT had successful reduction (PVR < or = 2.5 WU and TPG < or = 12 mm Hg) using prostaglandin I2 or E1. Posttransplant early and late mortality and incidence of right heart failure were studied. RESULTS: Two hundred seventeen patients were included in this study. Of these, 168 had normal pulmonary pressures (non-PHT group), 49 (22.6%) had reversible PHT (rev-PHT group). Mean PVR was 1.6 +/- 1.1 WU vs 2.1 +/- 1.1 WU (p < 0.01; non-PHT vs rev-PHT) and mean TPG 8.0 +/- 1.9 mm Hg vs 10.6 +/- 4.1 mm Hg (p = not significant [NS]). Thirty-day survival after orthotopic cardiac transplantation was 85% vs 78% (p = 0.150) and 10 year survival 63% vs 61% (p = NS). Right heart failure during the first 30 days after transplantation occurred in 27% in the non-PHT group and in 64% in the rev-PHT group (p = 0.035). However, in patients transplanted after 2001 it did not appear. CONCLUSIONS: Cardiac transplant candidates with reversible PHT have still significantly elevated pulmonary pressures compared with patients without PHT. Despite a significantly higher risk of right heart failure, long-term survival after orthotopic cardiac transplantation was not affected.

Adult↗
PubMed2003

Pre-transplant Th1 and post-transplant Th2 cytokine patterns are associated with early acute rejection in renal transplant recipients.

In this retrospective study, we tried to define pre- and post-transplant immunological parameters that identify patients at risk for early acute rejection. Lymphocyte subpopulations and plasma levels of cytokines and neopterin were determined pre- and post-transplant in 32 renal transplant recipients with biopsy-proven early acute graft rejection. Recipients without early acute rejection served as controls. High pre-transplant interferon-gamma (IFN-gamma) plasma levels (p = 0.006), consistently high levels of neopterin early post-transplant (p = 0.008), a post-transplant switch from a Th1 to a Th2 cytokine pattern with decreasing IFN-gamma (p = 0.02), low CD8+ lymphocyte counts (p = 0.006) and consistently high CD19+ B lymphocyte counts were associated with acute rejection. Our data suggest that patients with a pre-transplant Th1 and an early post-transplant Th2 cytokine pattern are pre-disposed for early acute rejection.

Adult↗
PubMed1994

Organ procurement and renal transplants in Spain: the impact of transplant coordination. Spanish National Transplant Organization (ONT)

The growing shortage of cadaveric organ donors remains the major obstacle to achieve satisfactory rates of transplantation. In Spain an integrated transplant organization programme, mainly focusing on organ procurement, has been established, based on a network of well-trained transplant coordinators. In every hospital that was a potential candidate for donor procurement, a transplant coordinating team was founded, including medical doctors and nurses (42% of whom belonged to renal units). The team was put in charge of all steps of transplant procurement, from locating potential donors to the organ grafting or tissue banking. The teams were integrated into a National Organization of Transplants (ONT), i.e. a coordinating structure without executive function. The annual rate of cadaveric organ donors increased from 14.3 per million population (p.m.p.) in 1989 to 21.7 donors p.m.p. in 1992. Total solid organ retrieval rate increased by 81% and renal transplants by 44% during the same period (from 1039 to 1492, i.e. from 26 to 38.8 renal transplants per million population, 99% of which were kidneys from cadaveric donors). This successful approach has overcome obstacles such as untrained or undertrained staff, failure to identify donors, or reluctance to approach grieving families.

Humans↗
PubMed2000

Decreased donor-specific cytotoxic T cell precursor frequencies one year after clinical lung transplantation do not reflect transplantation tolerance: a comparison of lung transplant recipients with or without bronchiolitis obliterans syndrome.

BACKGROUND: Decreased in vitro T cell alloreactivity, demonstrated by decreased frequencies of peripheral blood donor-specific T cell precursors, may reflect a tolerant state after transplantation and lower the risk for development of chronic graft dysfunction. It is unknown whether a decrease in donor-specific T cell frequencies also occurs after clinical lung transplantation and if such a decrease lowers the risk for bronchiolitis obliterans syndrome (BOS), a hallmark of chronic graft dysfunction. Therefore, we compared changes in posttransplant donor-specific cytotoxic T lymphocyte (CTLp) and helper T lymphocyte precursor (HTLp) frequencies in lung allograft recipients with good graft function and in recipients with BOS. METHODS: Donor and third party specific CTLp and HTLp frequencies were determined by limiting dilution assay in pre- and posttransplant (1 year) peripheral blood samples of lung allograft recipients with good graft function (n = 13) and BOS (n = 10). RESULTS: In recipients with good graft function, mean donor-specific CTLp frequencies decreased after transplantation (183 vs. 16 precursors before and after transplantation, respectively). Additionally, HTLp frequencies decreased but this was not specific for donor alloantigens because third party-specific HTLp frequencies decreased also. Surprisingly, recipients with BOS also showed a decrease in mean donor-specific CTLp frequencies after transplantation (332 vs. 49 precursors before and after transplantation, respectively). Again, HTLp frequencies decreased nonspecifically. CONCLUSIONS: We conclude that donor-specific CTLp frequencies decrease after lung transplantation, but that this does not result in transplantation tolerance protecting the lung against the development of chronic graft dysfunction.

Acute Disease↗
PubMed1996

Three hundred patients referred for lung transplantation. Experiences of the Dutch Lung Transplantation Program. Groningen Lung Transplantation Group.

In November 1990, a lung transplantation program began at the University Hospital in Groningen, the Netherlands. As of April 1994, 300 patients were referred for lung transplantation and we investigated the decisions that have been made concerning these referrals up to January 1, 1995. The patients were evaluated according to a stepwise procedure. In stage 1, written information about the referred patients was discussed during the weekly, multidisciplinary lung transplantation meeting. In this stage, 14% of the patients were rejected and 2% were postponed. If no major objections for transplantation were identified, the patient was invited for a visit to the outpatient clinic, stage 2. The newly acquired information from that visit was discussed again at the transplantation meeting. In this stage, 11% of the patients were rejected and 18% postponed. The remaining patients underwent an (partial or complete) inpatient evaluation, stage 3. From all patients about whom a decision was made in this stage, only 5% were rejected, respectively 35% after partial evaluation and only 1.5% after complete evaluation. A total of 110 patients (37% of all referred patients) were listed for lung transplantation, stage 4. Of the listed patients, 20% died while awaiting an appropriate donor. The group of patients with COPD/emphysema had by far the lowest death rate on the waiting list. Patients with short stature (< or = 1.65 m) had a much higher risk to die on the waiting list compared with patients with longer stature, 42% vs 13%. As of January 1, 1995, 55 patients have undergone transplantation, which is 50% of all patients on the waiting list and 18% of all referred patients. The stepwise selection procedure identifies patients with potential contraindications at an early stage. In this way, unrealistic expectations and unnecessary examinations, expense, and/or hospital admissions may be prevented. Donor shortage, and thus waiting list problems, still remains a significant drawback in the further development of lung transplantation.

Algorithms↗
PubMed1995

[Immunological aspects of kidney transplantation in Switzerland 1981-1992. Swiss Transplant Work Group Kidney Transplantation].

Every year some 200-260 kidney transplants are performed in Switzerland, improving the quality of life of patients with end stage renal disease. The current organ shortage is delaying transplantation of the 400 patients on the waiting list, a situation which calls for optimal utilization of the available donor kidneys. It is well established that AB0-compatibility, negative cytotoxic crossmatch, and optimal immunosuppressive therapy including cyclosporin A are important for a favorable clinical outcome. To identify further factors influencing transplant outcome, we undertook a retrospective study of all 1656 transplants to which the above criteria applied. We defined transplants matched for at least 1A, 1B, and 1DR HLA antigen as the better matched, and the remainder as the less well matched grafts. In patients who were not or only weakly immunized to alloantigens, the 5-year graft survival probability was 0.78 versus 0.69 for the better versus the less well matched transplants (p < 0.005). The strongly immunized patients did not, however, show a significant association between the degree of HLA matching and graft survival, presumably because there were more immunized patients in the HLA matched group. As expected, the patients previously immunized to alloantigens showed significantly reduced graft survival early after transplantation. Positive CMV serology, sex mismatch, and cold ischemia time did not correlate with graft survival. Compared to results obtained in the USA or Germany, the survival time of donor kidneys transplanted in Switzerland was significantly increased. Factors contributing to the good results in Switzerland are discussed. Future goals are reduction of alloimmunization and optimized HLA compatibility.

Cyclosporine↗
PubMed1998

Predictors of early mortality after heart transplantation: the Canadian transplant experience from 1981 to 1992. The CASCADE Investigators. Canadian Study of Cardiac Transplant Atherosclerosis Determinants.

OBJECTIVE: To determine risk factors for early death following transplantation in the Canadian heart transplant experience. METHODS: A retrospective multicentre study of the Canadian experience in heart transplantation was performed to evaluate the role of risk factors of early death within 30 days following transplantation. Eight hundred and thirty-three patients older than 15 years underwent cardiac transplantation between 1981 and 1992 in 10 centres across Canada. The association between risk factors and early mortality was analyzed with a multivariate logistic model to examine simultaneously the effect of all risk factors. RESULTS: Seventy-eight patients (9%) died during the first month following transplantation. Recipient age (P = 0.549), sex (P = 0.554) and body mass (P = 0.313) had no effect. Baseline pulmonary vascular resistance (P < 0.001) and systolic pulmonary pressure (P = 0.021) before transplantation were related to early death. Older donors (P = 0.027) were associated with a higher rate of early death but there was no relation with donor sex (P = 0.597), body mass (P = 0.413), blood group (P = 0.227) and ischemic time (P = 0.309). Patients with pulmonary vascular resistance of 6 or greater (Wood units) and donors older than 50 years had relative risks of early death five and two times, respectively, those of patients without these risk factors. CONCLUSION: Patient survival averaged 91% one month following transplantation in the Canadian experience between 1981 and 1992. The two predictors most strongly correlated with early death were elevated pulmonary vascular resistance at baseline and older donors.

Adolescent↗
PubMed2005

Pre-transplant IFN-gamma ELISPOTs are associated with post-transplant renal function in African American renal transplant recipients.

Final crossmatch testing is routinely used to assess the risk of antibody-mediated graft injury/rejection post-transplant. Analogously, we postulated that quantitative measurements of anti-donor effector/memory T cells pre-transplant would independently assess post-transplant risk. To address this hypothesis, we determined the frequencies of pre-transplant, donor-specific interferon-gamma (IFN-gamma) enzyme-linked immunosorbent spots (ELISPOTs) and correlated the results with post-transplant outcomes in 37 African American recipients of deceased donor kidney transplants treated with tacrolimus- and sirolimus-based immunosuppression. A positive ELISPOT test (>25 spots/300,000 cells) was detected in 14 (38%) of 37 patients. The incidence of biopsy-proven acute rejection was 50% (7/14) in ELISPOT-positive versus 17% (4/23) in ELISPOT-negative patients (p=0.036). Calculated glomerular filtration rate (MDRD) at 12 months was 37+/-16 mL/min in ELISPOT-positive versus 55+/-20 mL/min in ELISPOT-negative patients (p=0.01). ELISPOT status remained a correlate of allograft function at 12 months by linear regression analysis (p=0.001), independent of rejection and other contributing variables. Pre-transplant donor-directed IFN-gamma ELISPOT assessment of anti-donor cellular immunity may function as a 'cellular crossmatch' and independently correlates with renal allograft function in African Americans receiving tacrolimus- and sirolimus-based immunosuppression.

Black or African American↗
PubMed1992

Simultaneous kidney-pancreas transplantation versus kidney transplantation alone: patient survival, kidney graft survival, and post-transplant hospitalization.

This study compared patient survival, kidney graft survival, and post-transplant hospitalization between patients who received simultaneous kidney and pancreas (SKP) transplants and those who received a kidney transplant alone (KTA). A total of 3,168 diabetic end-stage renal disease (ESRD) patients, ages 18-45, who began their first ESRD treatment between 1981 and 1989 and received their first cadaveric kidney transplant between 1986 and 1989 were selected for study; patient and kidney graft survival were followed until 1 March 1990. Twelve percent (380) of these patients received SKP transplants. No statistically significant difference in patient survival was found between SKP and KTA patients (p = 0.86). Kidney graft survival was statistically significantly higher for SKP patients than KTA patients (p = 0.008). Post-transplant hospitalization rates were statistically significantly higher for SKP patients (p < 0.001), indicating potentially higher post-transplant morbidity among this group.

Adolescent↗
PubMed2005

Long-term outcome of allogeneic PBSC transplantation in pediatric patients with hematological malignancies: a report of the Spanish Working Party for Blood and Marrow Transplantation in Children (GETMON) and the Spanish Group for Allogeneic Peripheral Blood Transplantation (GETH).

We analyzed the clinical outcome in 90 children undergoing allogeneic PBSC transplantation from HLA-identical relative for leukemia. GvHD prophylaxis was CsA+ methotrexate in 50 and CsA+/-steroids in 40. Median CD34+ cells infused were 6 x 10(6)/kg (range, 1.4-32). Median follow-up was 60 months (range, 6-115). CI of transplant-related mortality (TRM) was 18.4+/-4%. On multivariate analysis, high Lansky score (>80) at transplantation was associated with lower TRM (HR, 0.9; P<0.0002). Relapse incidence (RI) was 33.6+/-6%. On multivariate analysis, high Lansky score at transplantation and cGvHD were associated with lower RI (HR, 0.04; P<0.0005 and HR, 0.23; P<0.03, respectively). Disease-free survival (DFS) was 57.8+/-5%. Disease status at transplantation (HR, 0.33; P<0.02), steroid treatment at day +90 (HR, 5.61; P<0.005) and cGvHD (HR, 0.23; P<0.005) had a significant impact on DFS in multivariate analysis. CI of cGvHD was 63.7+/-7%. Patients with cGvHD had better DFS (65+/-5%) because of lower RI (15.7+/-6%) and similar TRM (27.4+/-4%). These data suggest acceptable long-term outcomes after allogeneic PBSC transplantation in children despite the high incidence of cGvHD. These patients had a lower risk of relapse and a better DFS.

Adolescent↗
PubMed1999

[The National Heart Transplant Registry. The 9th Official Report (1984-1997). The Spanish Heart Transplant Groups. The Section of Heart Transplantation of the Spanish Society of Cardiology].

The results of the Spanish National Registry of Heart Transplantation, made up of 12 centers currently performing transplantation are reported. 318 transplantations performed in 1997, which, together with those performed since 1984, totals 2, 406 transplantations. The number of procedures increased again last year, breaking the trend of recent years. This has probably been due to an increase in organ obtention and a reduction in the acceptance level required, necessary because the waiting list has increased. Over 100 variables have been analyzed per patient to measure mortality predictors. The results are comparable to those published by the International Society of Heart and Lung Transplantation. Early survival, at the first 30 days post-transplantation, is lower in the National Registry, though 1-year survival tends to be higher, with a 3% fall in the National Registry and 4% in the International one. In conclusion, heart transplantation is a procedure completely established in Spain, with results comparable to those of the International Registry, due to the great experience of the centers.

Adult↗