Trasplante cardíaco ortotópico: resultados del Hospital Universitario Fundación Favaloro;
Orthotopic Heart Transplantation: Results from the Hospital Universitario Fundación Favaloro

RESUMENIntroducciónLos resultados favorables a lo largo de cuatro décadas de experiencia clínica han consolidado al trasplante cardíaco como el tratamiento de elección en la insuficiencia cardíaca refractaria a todo tratamiento y lo convierten en la terapéutica de elección.ObjetivoComunicar los resultados de pacientes con trasplante cardíaco ortotópico realizados en el Hospital Universitario Fundación Favaloro con 16 años de seguimiento.Material y métodosSe analizaron retrospectivamente 335 trasplantes cardíacos ortotópicos consecutivos efectuados en 333 pacientes entre febrero de 1993 y diciembre de 2009. El seguimiento fue del 94%. El 7% fueron trasplantes cardíacos pediátricos y el 2%, cardiorrenales. El 35% de los pacientes eran portadores de miocardiopatía isquémico-necrótica. En el 42% (142 pacientes) fueron electivos y en el 58% (193 pacientes) se realizaron en urgencia/emergencia. La supervivencia se analizó mediante curvas de Kaplan-Meier.

BackgroundThe favorable outcomes achieved during four decades of clinical experience have consolidated heart transplantation as the treatment of choice of refractory heart failure. ObjectiveTo report the outcomes of patients undergoing orthotopic heart transplantation at the Material and MethodsA total of 335 consecutive orthotopic heart transplantations performed in 333 patients from February 1993 to December 2009 were retrospectively analyzed. Follow-up was 94%. Seven percent corresponded to pediatric heart transplantation and 2% to heart-kidney transplantation. Thirty five percent of patients had ischemic cardiomyopathy. Transplants were elective procedures in 42% of cases (142 patients) and 58% (193 patients) were urgent/emergency procedures. Survival was analyzed using Kaplan-Meier curves.ResultsSurvival rates at 1, 5, 10 and 15 years were 80%, 74%, 71% and 65%, respectively. There were no significant differences between elective and urgent/emergency procedures. Survival was also similar for the different etiologies, even in patients with Chagas cardiomyopathy. In-hospital mortality was 12.5%, with no significant differences between elective and urgent/emergency procedures. After the first year, the incidence of severe cellular rejection was < 3%. The global incidence of humoral rejection was 4.5%.  Lymphoproliferative syndrome was diagnosed in 11 patients (3.5%). Twenty one percent of patients developed kidney failure, 24% diabetes mellitus, 69% hypertension and 70% dyslipemia.ConclusionIn our center, survival rates after heart transplantation at 1, 5, 10 and 15 years were 80%, 74%, 71% and 65%, respectively.Hospital Universitario Fundación Favaloro during 16 years of follow-up.