Interval	Summary status
3 weeks post-op (1990)	Mild cardiac rejection. Intensive prednisolone therapy. Full recovery.
1 year (1991)	LDL-C normalised. Cardiac and hepatic graft function satisfactory. Tendon xanthomata regressing.
5 years (1995)	Excellent ongoing graft function. Lipid control maintained. Cyclosporin dose progressively reduced.
10 years (2000)	Long-term stability. Renal function under surveillance as cyclosporin exposure accumulates.
15 years (2005)	Progressive renal impairment developing. Both grafts functional.
17 years (2007)	Conversion from cyclosporin to sirolimus-based regimen in attempt to preserve renal function. Creatinine 285 μmol/L11.
20 years (2010)	EF 68%; fractional shortening 30%; coronary calcification score 0. LDL-C 4.3 mmol/L on atorvastatin. End-stage renal failure established; haemodialysis commenced11.
23 years (2013)	Biopsy-confirmed Grade 1R cardiac rejection on sirolimus. Pulse methylprednisolone. Converted to ciclosporin. Full cardiac recovery.
24 years (2014)	Presumed rejection episode; pulse methylprednisolone (negative biopsy). Ciclosporin maintained.
28 years (2018)	Benign right breast lesion excised. No malignancy confirmed.
30 years (2020)	Both grafts functioning. Permanent haemodialysis via right brachiocephalic AV fistula.
33 years (2023)	Progressive CAV on surveillance imaging. Carotid Doppler: bilateral calcified plaques, <50% stenosis. AV fistula haemorrhage requiring surgical revision.
34 years (2024)	CTCA: progressive LAD calcification, increasing ostial circumflex stenosis, mild RCA and LM stenosis. EF 68%. Fall and femoral fracture: 3-month admission; pneumonia; deconditioning.
35 years (2025–2026)	MPS 05/2025: normal perfusion; EF 75%. Echo 05/2026: EF 64%. DSA negative. Ciclosporin dose adjusted. Bilateral arm weakness under investigation. Rotator cuff tear; frozen shoulder; left hip osteoporosis. Atypical chest symptoms under surveillance. Ongoing haemodialysis.