Abstract: Objective To summarize and analyze the clinical efficacy and experiences of orthotopic cardiac transplantation for end-stage heart disease. Methods Data of 40 patients underdoing orthotopic heart transplantation in our center in the past 10 years were retrospectively reviewed. The enrollments included 29 cases of dilated cardiomyopathy, 6 cases of ischemic heart disease, 4 cases of hypertrophic cardiomyopathy, and 1 case of restrictive cardiomyopathy. Immunosuppressive therapy with cyclosporine A, corticosteroid, and mycophenolate mofetile was adopted. Thirty-five patients received induction therapy with Tac monoclonal antibody or basiliximab monoclonal antibody. According to trough concentration (C0) and peak concentration (C2), the dose of cyclosporine A was regulated. Results The rate of successful operation was 95% (38/40). The 1-, 3-, 5- year survival rate was 90%, 82.5%, and 77.5%. Main causes of death were right heart failure, fungal infection, and graft failure. Acute rejection occurred in 7 cases (17.5%), and all recovered after cortieasteriod impulse therapy. Three cases were diagnosed as rejection after C0 and C2 were monitored spontaneously. Conclusion It's reliable to treat patients with end-stage heart disease with orthotopic cardiac transplantation. Monitoring C0 and C2 can control the cyclosporine concentration within the valid range and avoid occurrence of early acute rejection.

Key words: Infection, Heart transplantation, Immunosuppressive therapy, Cyclosporine concentration, End-stage heart disease