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Heart transplantation: state of the art
T K Rourke1, M T Droogan, L Ohler
1Cardiomyopathy and Transplant Center, Temple University Hospital, Philadelphia, PA 19140, USA.
Insights
Cardiac transplantation outcomes have improved due to medical and surgical advances. Expanded donor criteria are being evaluated to meet transplant demand, with ongoing research into tolerance induction and alternative therapies.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Cardiac transplantation outcomes have significantly improved over the last 30 years.
- Rigorous multidisciplinary evaluations are standard for determining heart transplant candidacy.
- The demand for heart transplants outpaces donor availability, necessitating expanded donor criteria.
Purpose of the Study:
- To review advancements in cardiac transplantation.
- To discuss the expansion of donor criteria and its implications.
- To explore emerging research and future alternatives in cardiac transplantation.
Main Methods:
- Review of medical and surgical advancements in cardiac transplantation.
- Analysis of expanded donor criteria, including age, ischemia time, and donor-recipient matching.
- Overview of ongoing research in tolerance induction and rejection detection.
- Discussion of alternative therapies such as ventricular assist devices and artificial hearts.
Main Results:
- Improved patient outcomes in cardiac transplantation over three decades.
- Implementation of extended donor criteria in some centers to address donor shortages.
- Ongoing evaluation of long-term outcomes associated with expanded donor criteria.
- Active research into novel approaches like bone marrow infusion for tolerance and pacemaker-based rejection detection.
Conclusions:
- Cardiac transplantation has seen remarkable progress, but donor scarcity remains a challenge.
- Expanded donor criteria represent a necessary adaptation to meet transplant demand.
- Future research and alternative technologies hold promise for advancing cardiac replacement therapy.
Abstract:
Outcomes in cardiac transplantation have improved during the past 30 years because of advances made in medicine and surgery. Patients referred for cardiac transplantation are examined through a rigorous evaluation process that involves a multidisciplinary approach to determine candidacy. The list for candidates awaiting transplantation has grown more rapidly than the donor pool, resulting in a need to expand the criteria for donors. Some centers now extend criteria to include older donors, those with prolonged periods of ischemia, donor-recipient mismatches, and donors requiring bypass surgery. Long-term outcomes from the expanded donor pool are under evaluation. Studies are currently in progress to explore inducing tolerance through bone marrow infusion and rejection detection with the use of a pacemaker. Future alternatives to transplantation include the left ventricular assist device as a bridge to recovery, xenotransplantation, and the totally artificial heart.