Cardiac transplantation in the United States: an analysis of the UNOS registry.

Cardiac transplantation is an important option to those with end-stage heart disease. About 2,000 heart transplants are performed each year in the United States. This number has remained relatively stable due to a lack of donors. The major indications for cardiac transplant were coronary artery disease and dilated cardiomyopathy, but over the past 20 years, dilated cardiomyopathy has supplanted coronary artery disease as the major cause. Survival rates have improved with the advent of newer immunosuppressive agents (tacrolimus and mycophenolate). The median survival for 43,906 heart transplants was approximately 9 years. At 20-years the survival rate continued to decline to reach < 10%. Seven-year survival rates for heart transplant recipients transplanted between 1998-1994, 1995-2000, and 2000-2007 were 59%, 62% and 65%, respectively. Infant heart recipients (less than one year old) had poor survival rates during the first post-transplant year (74% compared to > 85% for all other age groups), but those who survived had better long-term outcomes than adults. Elderly recipients (aged 65 or older) had survival rates comparable to younger patients through about 8 years, when survival rates began to fall more rapidly. The long-term success of cardiac transplants still has room for improvement.