Five-year experience with triple-drug immunosuppressive therapy in cardiac transplantation

Maria Teresa Olivari, Spencer H. Kubo, Elizabeth A. Braunlin, R. Morton Bolman, W. Steves Ring

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Although triple-drug immunosuppression with a combination of cyclosporine, prednisone, and azathioprine has been shown to improve short-term survival after cardiac transplantation, its long-term effects still are unknown. From December 1983 through December 1988, all patients (N=139) who underwent orthotopic cardiac transplant at our institution received triple-drug immunosuppressant therapy. Follow-up averaged 32.2 ± 15.8 months. Twenty-one patients died; 134 survived more than 30 days. Actuarial survival was 92% at 1 year, 85% at 3 years, and 78% at 5 years. Twenty-five episodes of acute graft rejection were diagnosed in 21 of the 139 recipients (0.18 episode per patient). In patients, the incidence of infection was 0.82 episode; 72% of infections were viral, with 10% due to cytomegalovirus. The incidence of coronary artery disease was 10% at 1 year, 25% at 3 years, and 36% at 5 years. Coronary artery disease was responsible for 60% of late deaths. Arterial hypertension developed in 81% of patients, despite relatively well-maintained renal function (serum creatinine, 1.7 ± 0.3 mg/dl). Skeletal complications occurred in 15.8% and lymphoma in 1.4% of recipients. Complete long-term rehabilitation was achieved in all but two of the surviving patients. These data support the short- and long-term effectiveness of triple-drug therapy. This regimen reduces the incidence of rejection, infection, and lymphoma, as well as the degree of renal failure. However, the incidence of posttransplant coronary artery disease has not been reduced, and graft atherosclerosis represents the major cause of late graft failure and death.

Original languageEnglish (US)
JournalCirculation
Volume82
Issue number5 SUPPL.
StatePublished - 1990

Fingerprint

Heart Transplantation
Immunosuppressive Agents
Drug Therapy
Coronary Artery Disease
Incidence
Transplants
Lymphoma
Survival
Azathioprine
Graft Rejection
Virus Diseases
Prednisone
Infection
Cytomegalovirus
Immunosuppression
Cyclosporine
Renal Insufficiency
Creatinine
Atherosclerosis
Rehabilitation

Keywords

  • Heart transplantation
  • Immunosuppression
  • Long-term outcome

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Olivari, M. T., Kubo, S. H., Braunlin, E. A., Morton Bolman, R., & Steves Ring, W. (1990). Five-year experience with triple-drug immunosuppressive therapy in cardiac transplantation. Circulation, 82(5 SUPPL.).

Five-year experience with triple-drug immunosuppressive therapy in cardiac transplantation. / Olivari, Maria Teresa; Kubo, Spencer H.; Braunlin, Elizabeth A.; Morton Bolman, R.; Steves Ring, W.

In: Circulation, Vol. 82, No. 5 SUPPL., 1990.

Research output: Contribution to journalArticle

Olivari, MT, Kubo, SH, Braunlin, EA, Morton Bolman, R & Steves Ring, W 1990, 'Five-year experience with triple-drug immunosuppressive therapy in cardiac transplantation', Circulation, vol. 82, no. 5 SUPPL..
Olivari, Maria Teresa ; Kubo, Spencer H. ; Braunlin, Elizabeth A. ; Morton Bolman, R. ; Steves Ring, W. / Five-year experience with triple-drug immunosuppressive therapy in cardiac transplantation. In: Circulation. 1990 ; Vol. 82, No. 5 SUPPL.
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