Risk factors for total and cause-specific mortality in human cardiac transplantation Prolonged extracorporeal bypass time: a high risk factor for rejection and infection
Data from the first 103 human heart transplantations in 100 recipientsperformed at a single centre from November 1983 to January 1990 wereanalysed to detect risk factors for overall and cause-specific mortality.Twenty-two patients died. Cumulative 1 year graft survival was 82% and 5year, 68%. Acute and chronic rejection was the cause of death in 9patients, disseminated infection in 8 and cancer in 3. One patient diedfrom cerebral haemorrhage and 1 from acute cardiac failure. The meanobservation time was 803 days (range: 1-2 308 days). Total follow-up was226.6 graft years. Risk factors were analysed by univariate andmultivariate methods. The type of immunosuppression regimen and recipientage above 50 years were independent risk factors for mortality.Histocompatibility mismatching (HLA-DR) and type of immunosuppression wereindependent risk factors for lethal rejection and a female recipient was anindependent risk factor for lethal infection. Prolonged time onextracorporeal bypass was an independent risk factor for both lethalrejection and infection, and also for overall mortality. The impact ofextracorporeal bypass time on rejection and infection is discussed, and theimportance of prospective HLA matching in heart transplantation isstressed. The association between recipient female sex and infectionremains uncertain.