Heart Transplantaion : Early Results and 2-Year Survival

摘要

Background The heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in human was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 25 cases have been performed in Korea. The purpose of this study is to evaluate the early results and the follow-up course of 9 cases of heart transplantation done in Asan Medical Center. Methods Total 9 patients had orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The No. of male patients was 7 and the average age of 9 patients was 41 years old(20-51). The preoperation status was status I in 5 patients and status II in 4 patients. The mean follow-up duration was 9.5 months(2-26). All patients are alive till now. Results 1) The blood type was identical in 6 and compatible in 3 patients. 2) The original heart disease was dilated cardiomyopathy in 7, ischemic cardiomyopathy in 1 and giant cell myocarditis in 1 patient. 3) IgG Ab for CMV was positive in all recipients and donors and igM Ab for CMV was positive in only one reipient. The serial cultures for CMV shell vial method have been negative till now. 4) HLA cross matching for recipient and donor was done in 8 cases and the results were all negative for T-cell and B-cell. Among 6 loci of A, B and DR, one locus was matched in 4 cases and 2 loci was matched in 2 cases. 5) The No. of acute allograft rejection per case was average 3.7(1-6) and the No. of acute allograft rejection requiring treatment was average 1.4(1-3) per case. The time interval from operation to the first acute rejection requiring treatment was 40 days(5-60). Acute humoral rejection was supected strongly in 1 case and was successfully treated. 6) The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 15%(10-24) to 59%(45-70%) after heart transplantation. 7) Temporary pacing was needed in 2 parients over24 hours but normal sinus rhythm was appeared within 7 day in all cases. One patient had permanent pacemaker due to complte AV block appeared 140 days after heart transplantaion. Conclusion The heart transplantation of Asan Medical Center is on developing stage but the early result is comparable to that of well established center in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in parients with terminal heart failure.