Outcome domain	Status at 35 Years
Cardiac graft survival	In situ and functioning at 35 years. EF 64% (echo 05/2026); EF 75% on MPS (05/2025). Progressive CAV on CTCA (2024) without haemodynamic compromise.
Hepatic graft survival	Liver graft functioning throughout follow-up. No hepatic decompensation or graft failure documented.
Metabolic correction (LDL-C)	LDL-C reduced from 13 mmol/L (pre-operative) to 2.1 mmol/L (10 days post-operative); sustained long-term. Late residual hypercholesterolaemia on atorvastatin 10 mg od and ezetimibe 10 mg od, likely secondary.
Cardiovascular outcomes	Prior CVA. Progressive CAV (CTCA 2024). No inducible ischaemia (MPS 2022, 2025). No acute MI documented post-transplant. Residual carotid atherosclerosis (<50% stenosis bilaterally).
Rejection incidence	Two confirmed episodes across 35 years (3 weeks post-op; 2013). One probable episode (2014). Low overall burden; consistent with hepatic immunological privilege.
Renal function	End-stage renal failure secondary to CNI nephropathy. Permanent haemodialysis (Tue/Thu/Sat). Right brachiocephalic AV fistula.
Skeletal morbidity	Steroid-associated osteoporosis. Low-impact femoral fracture (2024); conservative management. Left hip osteoporosis pain limiting mobility. Rotator cuff tear and frozen shoulder.
Malignancy	Benign right breast lesion excised 2018. No confirmed malignancy across 35 years.
Functional status	Mobilising at home with walker; requires carers three times per week. Attends dialysis independently. Bilateral upper limb weakness limiting self-care. Physiotherapy ongoing.