Sensitivity, ventricular assist devices, and the waiting game in heart transplantation: what's new?

Orthotopic heart transplantation became more successful with the introduction of cyclosporine in the late 1970s. Although congestive heart failure has become a significant public health issue and the proportion of patients with advanced heart failure has increased, the number of heart transplants performed has not increased substantially in the past decade. Transplant waiting times have been related to many different factors. Unfortunately, implantation of ventricular assist devices (VADS) may provoke antibody responses. These result in the sensitization of patients and increased waiting time prior to transplantation. The purpose of this article is to explore etiologies of waiting times for pre heart transplant and left ventricular assist device pre heart transplant candidates, explain new theories of sensitization, define current methods to detect sensitization, and discuss nursing care implications.