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Lung Transplant Research Hannover
Fig. 11.4. Relationship between cardiac output and oxygen consumption in the transplanted heart. From: Perloth MG, Reitz BA. Heart and heart-lung transplantation. In: Braunwald E, ed. Heart Disease, 5th Ed.n, Philadelphia: WB Saunders Company, 1997: 527.

achieved one-year survival rates of 90% or higher. Beyond the first year, the annual mortality is approximately 4%. Thus, the ISHLT data indicate three-year survival is 77% and the five-year survival is about 67% (Fig. 11.5). The average survival is nine years.

Quality of Life

The vast majority of transplant recipients achieve long-term survival and excellent functional recovery. In most transplant centers, at least 90% of survivors achieve complete rehabilitation and are classified as New York Heart Association

Class I. Nonetheless, little more than 40% return to work full-time. The reasons more recipients don't return to work full-time include insurance issues and chronic medical conditions. Those factors, more than inability to work, reflect the difficulties patients have with employment.

Cardiac Allograft Vasculopathy

Cardiac allograft vasculopathy (CAV) is the achilles heel of cardiac transplantation. In fact, the first long-term survivor of heart transplantation died one and one-half years posttransplant with severe CAV in 1969. Today CAV is the leading cause of death among patients > one year posttransplant. Unlike atherosclerotic coronary artery disease, which usually creates localized areas of eccentric stenosis in the epicardial coronary arteries, CAV is manifested by an accelerated form of

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