Background: The objective of this study was to evaluate short and long-term complications after cardiac transplantation. Methods: Between February 1998 and June 2002, 21 patients (15 male and 6 female; mean age 43.7 ± 14.2 years) underwent cardiac transplantation. Etiology was idiopathic dilated cardiomyopathy in 13 patients (61.9%), ischemic cardiomyopathy in 7 (33.3%), and valvular heart disease and dilated cardiomyopathy in 1 (4.8%). Orthotopic cardiac transplantation using biatrial technique was used in all patients.

Results: The mean cardiac ischemia time was 163.9 ± 59.5 minutes (101-335). Perioperative mortality was 14.3% with 3 deaths. Five patients were expired in postoperative period. Inotropic support was needed for 9 patient (42.8%) at early postoperative period. All patients were extubated within 24 hours except 3 of them. Right ventricular failure, acute rejection and acute renal failure were the most prominent complications during perioperative period. Acute rejection (9 patients, 42.8%) and infection (11 patients, 52.4%) were responsible most of the morbidities at early follow-up period. In one patient lymphoproliferative disease in lung was seen at two months after transplantation. Mortality was seen in 3 patients within postoperative 6 months. Fatal mediastinal lymphoproliferative disease was observed in one patient, and Kaposi’s sarcoma of foot in the other during late follow-up period. In considerable number of patients, side effects of immunosuppressive therapy such as hypertension (7 patients, 33.3%), chronic renal dysfunction (5 patients, 23.8%), insulin dependent diabetes (2 patients, 9.5%) and hyperlipidemia (9 patients, 42.8%) were seen at late follow-up period. In 2 patients, allograft vasculopathy was detected in coronary angiography and intravenos ultrasonography during late follow-up period.

Conclusions: In short-term follow-up, acute rejection and infection play a dominant role in mortality and morbidity. The predominant causes of morbidity in long-term follow-up are related with metabolic side effects of immunosuppressive therapy as well as malignancies and allograft vasculopathy.

Keywords : Cardiac transplantation, end stage heart failure, immunosuppression