Various immunosuppressive and adjunctive pharmacological regimens exist for
cardiac transplantation, though the associations between these regimens and long-term survival are unclear. We reviewed demographic, clinical, and pharmacological data from 220 consecutive adult heart transplant recipients between 1986 and 2003 who survived beyond 3 months. Immunosuppression was
cyclosporine-based (n=94) or
tacrolimus-based (n=126), and 104 patients were weaned off
steroids (all receiving
tacrolimus). Covariates of mortality were assessed in a Cox proportional hazards analysis. The mean age was 5.2+/-13 years. Survival was 96%, 88%, and 81% at 1, 3, and 5 years, respectively. Significant covariates associated with mortality included pretransplant
diabetes mellitus (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.45 to 5.04), black race (HR 1.41, 95% CI 1.01 to 1.94), higher pretransplant
creatinine clearance (HR 0.99, 95% CI 0.98 to 1.00),
steroid withdrawal (HR 0.60, 95% CI 0.39 to 0.85), and exposure to a
statin (HR 0.53, 95% CI 0.40 to 0.70) or an
angiotensin receptor blocker (HR 0.50, 95% CI 0.20 to 0.95) after
transplantation. Treatment with a
statin, an
angiotensin receptor blocker, and
steroid withdrawal were each associated with improved survival in heart transplant recipients. These findings warrant prospective study, with specific emphasis on identifying the clinical effects of these medications in transplant recipients.