Cardiac transplantation at The Cleveland Clinic Foundation: the first twenty-four months

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From August 15, 1984 until August 15, 1986 184 patients at The Cleveland Clinic Foundation were screened for cardiac transplantation, 53 were accepted, and 37 received orthotopic transplants. Recipients ranged in age from 14 to 58 years; in 60% the underlying disease was a cardiomyopathy. Follow-up was complete in all cases; the shortest period was 6 months. In the most recent of four immunosuppressive protocols, cyclosporine's nephrotoxicity has been neutralized without compromising immunosuppression. Ten patients have died, producing a one-year actuarial survival of 80.3%. Two of the early and three of the late deaths were from infections (viral, fungal, and Nocardia). During the first 90 days following transplantation, rejection occurred 60 times in 27 patients. No patient died or required retransplantation because of rejection. Additionally, neither malignancy nor allograft atherosclerosis have occurred. Functionally, 93% of survivors report normal tolerance for activities. Cardiac transplantation provided acceptable results for individuals who would die of otherwise untreatable cardiac disorders.



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