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This article describes four years' experience with heart transplantation using conventional immunosuppression. Twenty of 32 patients are alive. The one-year survival rates were 75% (1979), 67% (1980), and 75% (1981). Actuarial survival rates for operative survivors were 70% at one year, 60% at two years, and 51% at three years. Patients in the 50- to 55-year age group have survived as well as younger recipients. Rejection resulted in six deaths, infection in three, donor heart failure in two, and multiple organ failure in one. There were 1.5 acute rejections per patient and one infection per patient in the first three posttransplant months. Postoperative hospital stay averaged 62 days and cost a total of $58,351.

Eighteen serious pulmonary infections have been encountered in 10 of 16 surviving cardiac transplant recipients. Fourteen of 18 infections (78%) occurred within the first six months after transplant and the remaining 4 (22%) after the first six months (p less than 0.05). There was no correlation between the number of rejections per patient and propensity toward infection. Transtracheal aspiration or percutaneous lung aspiration established the diagnosis in all but two episodes. Percutaneous lung aspiration appeared more accurate as a diagnostic tool but was associated with 6 complications in 13 attempts (46%), while no complications occurred in 17 attempts with transtracheal aspiration (p less than 0.05). Five of the 10 patients had multiple episodes of pulmonary infection; 2 of these 5 (40%) had concurrent infections. Nocardia organisms were encountered most frequently, accounting for 7 of 18 (39%) infections; 6 of 10 patients (60%) were infected with Nocardia at some point after transplant. Nine of 10 patients (90%) were cured of infection. Eight are still alive without evidence of infection. We conclude from these data that pulmonary infection is common in transplant recipients, that early definitive diagnosis, in spite of the potential complications, is warranted, and that cure of infection and long-term survival are possible if treatment is timely and aggressive.