Editor,—The recent study by Fraundet al has highlighted the improving survival of cardiac transplant recipients with a 10 year survival rate of approaching 50%.1 Functional status in long term survivors was encouraging with fewer than one in five patients experiencing (New York Heart Association) NYHA class III or IV symptoms. These findings reinforce cardiac transplantation as a valuable treatment option for patients with symptomatic severe left ventricular systolic dysfunction.

Disappointingly, the authors were unable to identify any useful factors that potentially could be used to predict long term outcome. Allograft vasculopathy is now emerging as the main factor limiting long term survival, and 39% of all deaths in the study were attributable to this …