Honoring 50 Years of Clinical Heart Transplantation in Circulation: In-Depth State-of-the-Art Review

Josef Stehlik, MD, MPH; Jon Kobashigawa, MD; Sharon A. Hunt, MD; Hermann Reichenspurner, MD, PhD; James K. Kirklin, MD


Circulation. 2018;137(1):71-87. 

In This Article

Posttransplantation Survival and Patient Quality of Life

The median survival of adult patients transplanted after the year 2000 exceeds 12 years, which represents a marked survival benefit compared with continued medical therapy for New York Heart Association stage IV heart failure.[18] The median survival of patients in this cohort who survive the first posttransplantation year is expected to reach 15 years. The median survival in pediatric heart transplantation is even longer, with >70% of recipients alive at 10 years after transplantation.[58]

Early after transplantation, the main causes of mortality include primary graft dysfunction, rejection, and infection. Later after transplantation, the leading causes of death include CAV, nonspecific graft failure, malignancy, and renal dysfunction.

An important goal of transplantation is to regain favorable quality of life and active lifestyle in patients with advanced heart failure. After the acute postoperative period, the majority of patients undergoing heart transplantation do not require hospitalizations, the functional status of 80% of heart transplant recipients is described as ≥80% on the Karnofsky Score (range, 10%–100%),[18] and other aspects of health-related quality of life are also improved significantly compared with before transplantation.[59] Many heart transplant recipients return to work, although securing of healthcare coverage can represent an obstacle for those seeking employment after heart transplantation.