Modern concepts in heart transplantation

In 1967, Christian Barnard performed the first successful human-to-human heart transplant. Following this triumph, the ensuing decade saw a waning interest in heart transplantation given the complications related to rejection and immunosuppression. With the introduction of cyclosporine immunotherapy in the early 1980s, however, success was more the rule than the exception, and cardiac transplantation became an acceptable therapy. Currently, heart transplantation is considered the gold standard therapy for end-stage heart failure refractory to medical treatment. One-year survival is now approximately 85%, and 10-year survival approaches 60%. While the main obstacles in the early years of heart transplantation were immunosuppression, the current issue at hand is organ availability. Approximately 2500 heart transplants are done yearly, but the list of candidates exceeds 50,000. What is perhaps even more alarming is the fact that while the number of heart transplants performed in the United States has dropped every year since 1994, the prevalence of heart failure increases every year and is predicted to do so into the year 2030. Nevertheless, the last 20 years has seen dramatic improvements in the ways we diagnose rejection, the fine-tuning of immunosuppressive regimens, and the advent of better preservation techniques. We have a better understanding of the causes of acute and chronic rejection and ways to treat these problems. Undoubtedly, we will continue to fine-tune the therapy in the years to come. This article is a review of the current indications, techniques, and medical therapies involved with cardiac transplantation.