Survival Beyond 10 Years Following Heart Transplantation: The Cleveland Clinic Foundation Experience V. Ozduran, M.H. Yamani, H.-H. Chuang, I. Sipahi, D.J. Cook, D. Sendrey, L. Tong, R. Hobbs, G. Rincon, C. Bott-Silverman, K. James, D.O. Taylor, J.B. Young, J. Navia, M. Banbury, N. Smedira, and R.C. Starling ABSTRACT Background. Long-term survival after heart transplantation is a desirable although challenging goal. Methods. We analyzed clinical outcomes in the cohort of 170 patients who have undergone heart transplantation at The Cleveland Clinic Foundation and survived 10 years. Results. We found 10-year and 15-year survival rates of 54% and 41%, respectively, in these patients, but there was also a high incidence of complications, such as hypertension, renal dysfunction, transplant vasculopathy, and malignancy. Conclusions. Long-term survival following cardiac transplantation is possible although complications are frequent. Beyond 10 years, malignancy is a major cause of death. O RTHOTOPIC heart transplantation (HTx) has be- come a widely accepted therapeutic modality for patients with end-stage heart failure. Long-term outcomes after transplantation have improved with the advances made in transplant candidate selection, surgical techniques, immunosuppression, and postoperative care. The current survival rate after heart transplantation has been reported as approximately 50% at 10 years by the International Society for Heart and Lung Transplantation (ISHLT) reg- istry. 1 This study is undertaken to determine the long-term (10 years) survival of patients who have undergone HTx at our institution, and to describe their clinical status after 10 years. METHODS Patient Population Between August 1, 1984 and May 31, 2004, a total of 1089 adult patients underwent HTx at the Cleveland Clinic Foundation. To study patients who survived beyond 10 years, we evaluated a consecutive cohort of 325 patients who underwent transplantation between August 1, 1984 and May 31, 1994. A total of 170 patients survived more than 10 years. We excluded 11 patients who under- went retransplantation during the first 10-year period. Data Collection Our data was retrieved from the Cleveland Clinic Foundation Heart Transplant Database, which is approved by the Institutional Review Board of our institution. Immunosuppressive Regimen Cyclosporine was administered as a part of initial immunosuppres- sion in all of the patients included in this study. Maintenance immunosuppression therapy consisted of cyclosporine, azathio- prine, and steroids. Follow-Up Patients underwent surveillance biopsies starting at 1 week after HTx, once weekly for the first month, every other week during the second month, and then every 6 – 8 weeks between the 3rd and 12th months. Subsequently, biopsy was performed every 3 months during the 2nd and 3rd year and then every 4 – 6 months during the 4th and 5th year. Coronary angiography was routinely performed at 1 month as the baseline after HTx and then annually for follow-up if not contraindicated. We defined significant graft coronary artery disease (GCAD) as 50% focal or diffuse stenosis in a main epicardial coronary artery. Minimal GCAD was defined as any lesion 50% in any coronary artery. Echocardiography was per- formed on 111 patients who were at 10 years after transplantation. From the Departments of Cardiovascular Medicine (V.O., M.H.Y., H.-H.C., I.S., D.S., L.T., R.H., G.R., C.B.-S., K.J., D.O.T., J.B.Y., R.C.S.), Allogen Laboratory (D.J.C.), and Cardiothoracic Surgery (J.N., M.B., N.S.), Cleveland Clinic Foundation, Kaufman Center for Heart Failure, Cleveland, Ohio, USA. Address reprint requests to Mohamad H. Yamani, MD, Cleve- land Clinic Foundation, Cardiovascular Medicine, F25, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: yamanim@ccf.org © 2005 by Elsevier Inc. All rights reserved. 0041-1345/05/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2005.10.021 Transplantation Proceedings, 37, 4509 – 4512 (2005) 4509