Abstract
The first human heart transplantation was performed by Christian Barnard in 1967. While the technical aspect had been worked out, allograft rejection was a major limitation in the early days of heart transplant. The discovery of cyclosporine revolutionized the field and led to the modern era of transplant. Heart transplantation now offers the best survival benefit for patients with end-stage heart failure with a median survival over 12 years. However, there are still limitations including the impact of limited availability of graft, graft dysfunction, and rejection, and long-term non-cardiac complications. This review serves as an update on the short- and long-term outcomes following heart transplantation focusing on the new donor allocation system, efforts to expand the donor pool, primary graft dysfunction, acute cellular and antibody-mediated rejection, cardiac allograft vasculopathy, and post-transplant malignancy and renal dysfunction.
Highlights
Heart transplantation (HTx) has evolved from a basic experimental model and miracle in human medicine to an expected choice on the menu of treatment for end-stage heart disease
This review presents a discussion on desensitization and serves as an update on outcomes following HTx with an emphasis on primary graft dysfunction (PGD), acute cellular rejection (ACR), antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV), and post-transplant malignancy and renal dysfunction
Orthotopic heart transplantation remains the ultimate modality of treatment for patients suffering from heart failure
Summary
Heart transplantation (HTx) has evolved from a basic experimental model and miracle in human medicine to an expected choice on the menu of treatment for end-stage heart disease. This review aims to discuss HTx with a focus on outcomes after the new allocation system and expansion of the donor pool; utilizing donors with hepatitis C virus, donors following circulatory death, and high-risk donors. The advent of mechanical circulatory support (MCS) has offered an alternative therapy to patients with a failing heart, and widened the candidacy for HTx. Advancements in MCS has led to improved 1-year survival of patients with ventricular assist devices (VAD) from 10.2% in 1996–2000 to 70% in 2011–2017 [4]. To maintain appropriate prioritization of candidates, the allocation system was recently revised [5]. This was done in the context of advances in durable MCS, percutaneous VADs and extracorporeal membrane oxygenator (ECMO) [6]. The medical treatment of heart failure has improved the survival and quality of life [7] for patients who were historically hospital bound with limited life expectancy
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