Clinical outcome and quality of life of patients surviving 20 years or longer after heart transplantation.

To evaluate outcome and quality of life (QoL) in >= 20years survivors after heart transplantation. Patients surviving >= 20years with a single graft were retrospectively reviewed. Heterotopic, multiorgan and retransplantations were excluded. QoL was evaluated using the SF-36 survey. Eight hundred and twenty-seven heart transplants were performed from 1981 to 1993, and among these, 131 (16%) patients survived >= 20years; 98 (75%) were male and mean age at transplant was 43 +/- 13years. Conditional survival in these 20years survivors was 74.1 +/- 4.3% at 23years and 60.9 +/- 5.3% at 25years (45 deaths, 34%). Forty-four (34%) patients suffered rejection >= 2R. Conditional survival free from rejection >= 2R was 68 +/- 4.1% at 5years and 66.4 +/- 4.2% at 10years. Thirty-five (27%) patients had cardiac allograft vasculopathy (CAV) grade 2-3. Conditional CAV-free survival was 76 +/- 3.8% at 20years and 72.1 +/- 4% at 25. Sixty-nine (53%) patients developed malignancy, mostly skin cancers. Conditional malignancy-free survival was 53.5 +/- 4.4% at 20years and 45.2 +/- 4.6% at 25years. At latest follow-up, 24.0 +/- 3.0years after transplantation, mean left ventricular ejection fraction was 62 +/- 11% and mean physical and mental scores were 57 +/- 23 and 58 +/- 21, respectively. Sixteen per cent of heart recipients survived >= 20years with good ventricular performance and QoL. CAV and malignancies account for late morbidity and mortality.