ABSTRACT
Introduction: The status of heart transplantation in Singapore is reviewed in this article. Materials and Methods: The database of 40 consecutive heart transplantations from July 1990 through December 2007 is reviewed retrospectively. The data is compared with the 2008 registry data of the International Society for Heart and Lung Transplantation (ISHLT). Results: The average age of recipients was 45.3 years. Ages ranged from 14 to 64 years. Ischaemic cardiomyopathy (52.5%) and dilated cardiomyopathy (42.5%) were the major indications. From 1990 to 1999, 50% of the donors sustained brain death from road traffic accident, 25% from cerebrovascular accident and 25% from falling from height, whereas the cause of brain death in the donors from 2000 to 2007 was 33%, 47% and 9.5%, respectively. The average donor age increased from 28.3 to 38.1 years. The significant morbidities in the recipients were hypertension, cytomegalovirus (CMV) infection, cardiac allograft vasculopathy and renal dysfunction. Thirty two required treatment for hypertension. 67.5% developed CMV disease requiring treatment. Cardiac allograft vasculopathy was diagnosed in 10. Rising creatinine levels reaching over 2.5 mg/dL was seen in 7. Three required renal dialysis. Epstein-Barr virus related lympho proliferative disorder occurred in 2 patients. One patient developed adenocarcinoma of stomach. The 30-day mortality was 10% and half life was 10 years. Cardiac allograft vasculopathy and sepsis caused 41.7% of mortality each. 11.7% of the mortality was due to cerebrovascular accident. Conclusion: The status of heart transplantation in Singapore is comparable to the ISHLT registry data. Transplant provides excellent early survival of 80%; however, the expected half life is around 10 years after cardiac transplantation. The late mortality is mainly caused by cardiac allograft vasculopathy (CAV) and renal failure. More effort and research needs to be directed towards these issues to improve the long-term results.
The introduction of cyclosporine as an immuno-suppressant in the early 1980s revolutionised the results of organ transplantation and made heart transplantation an accepted therapeutic modality for end-stage heart failure. The 2008 Registry Report of The International Society for Heart and Lung Transplantation (ISHLT) received 80,106 reports of heart transplants between 1982 and 30 June 2007.1 However, heart transplants remain a challenge in Asia. Although 60% of the world’s population lives in Asia, only about 4% of heart transplantations are performed in Asia.2 North America which has 5% of the world’s population performs 71% of transplantations and Europe with 12% of the world’s population contributed to 25% of the heart transplants performed.3 The number of cardiac donors in the United States (US) in year 2000 was 8 per million population (pmp), whereas in Asia it was 0.03 pmp.
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