Outcomes and Impact on Life Quality

Heart transplant represents the gold standard for end-stage heart failure. Through the years, the survival rate and outcomes of patients undergoing heart trans-plantation have progressively improved. However, short-and long-term complica-tions still represent a fundamental challenge for the transplant physician. As years go by, the risk of acute rejection, infection, and graft dysfunction, typical of the early period after transplant, reduces to be replaced by long-term complications linked to immunosuppressive therapy and progressive chronic rejection. Chronic rejection occurs, with Cardiac Allograft Vasculopathy (CAV), in around 50% of heart transplant recipients at ten years from heart transplantation, leading to even-tual graft dysfunction. Immunosuppressive therapy, through the years, is respon-sible for an augmented risk of malignancy, the leading cause of death after five years from heart transplant (22% of patients.). The most frequent are skin cancers, followed by post-transplant lymphoproliferative-disorders (PTLD) and other solid tumors. Progressive renal failure is another consequence of long-term immunosup-pressive therapy, especially with CNIs. End-stage renal failure (defined by serum Creatinine > 2.5 mg/dl, dialysis, or renal transplant) is experienced by 50% of heart transplant recipients within 15 years from heart transplantation. Furthermore, long-term immunosuppressive therapy with corticosteroids leads to a series of metabolic derangements, including diabetes, hypertension, dyslipidemia, obesity, which are recurrent conditions in heart transplant recipients.