A new study shows that survival rates for heart recipients are rising. Claire O'Connell reports
Survival rates for people who undergo a heart transplant in Ireland are improving, with around 77 per cent of heart recipients currently living for at least five years after the operation.
That's according to a new study published online this week in the Irish Journal of Medical Science.
Lead author Dr David Healy, a specialist registrar in cardiothoracic surgery, attributes the increasing survival rates to improvements both in medication and expertise.
The study followed up on 229 patients who received new hearts at Dublin's Mater Misericordiae Hospital since the first transplant there in 1985.
"It seemed appropriate to produce a summary of the activity after 20 years to show the success of the programme and to see if there were any problem areas," says Healy.
The study found that in the late 1980s around 80 per cent of heart transplant patients survived their hospital stay, and almost 62 per cent lived for over another five years.
Figures since 2000 show that now almost 86 per cent of heart recipients leave hospital alive and almost 77 per cent are still going strong five years later.
Early international attempts were not as successful. Dr Christiaan Barnard carried out the first heart transplant in South Africa in 1967, but in the following years heart recipients did not survive long after the operation.
"From the first one to about 1983 there were very few done and the success rate was so poor most people abandoned it," says Healy.
Then in 1983 the anti-rejection drug cyclosporine was approved for use in heart transplants. It dampens down the immune system and helps stop the body attacking the new organ as something foreign, and so makes transplants more viable.
"Suddenly you had lots of people trying it and succeeding," says Healy.
In tandem with the improved medication, teams caring for patients built up their expertise, which also helped survival rates.
"Because there were so few transplants done and so few people had survived up to the early 1980s, the experience worldwide with managing these patients was fairly limited," he says.
"But from 1983 to 1990 people worldwide were learning to manage the later complications, so the expertise was building over time with the experience," Healy says.
Still, the procedure is not without risk and Healy notes that patients are particularly vulnerable to infection because the anti-rejection drugs put the brakes on the immune system. In addition, the transplanted heart may not function well enough in its new surroundings.
"We're taking a perfectly viable and healthy organ and trying to put it into someone else," says Healy. "It's an unnatural state for that organ and it can take a while to recover - and sometimes it just doesn't recover."
But he says that heart transplant survival levels in Ireland are good and compare favourably with international rates. "They are surviving very well," he says. "And now we have someone who is 19 years out and still going strong."
The Mater team carries out an average of one heart transplant per month and there are about 20 people on the active transplant list.
The challenge is often to find a suitable donor organ before time ticks out for a patient, and the team has started to fit "cardiac assist" mechanical pumps into the hearts of critically ill patients to help maintain them until a match is found.
"There is quite a good donor rate in this country but relative to the number of people who need it, there is a shortfall," says Healy.
Heart transplant recipient Terry Mangan agrees with the need for more donors. Chairman of the European Heart and Lung Transplant Federation, he urges everybody to say yes to organ donation. Mangan adds that in Ireland the next of kin have the authority to permit organ donation, so it is essential for potential organ donors to talk to their families about their wishes while they can.
Ten years ago, an otherwise fit Mangan was struck with viral cardiomyopathy, an infection that attacks the muscle of the heart.
"I went into Christmas thinking I was coming down with flu," he says. "And by the middle of January I was told I needed a new heart."
Eight months later he got a call that a suitable donor had been found and within 12 hours, he had a new heart. Now in his 60s, he is extremely grateful for his additional years.
"Now that I have had 10 years I want another 10," he says.
He is optimistic about further developments in transplant medication and care, particularly for young recipients, who he says should not limit their expectations after surgery.
"Transplantation restores young people to a good and healthy and full life," he says. "You had a problem, it's mended and please God down the line there will be further improvements in the technology and the medication so in another 10 years people will be lasting 40 years after transplants."