[Indication, management and problems of cardiac transplantation]

Cardiac transplantation (HTx) remains one of the most important options for the management of end stage heart failure which is treated with optimal medical therapy. Evolving surgical techniques (implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT)) and mechanical device-therapie (ventricular assist devices (VAD)) and medical therapies have yielded incremental improvements in outcomes. These alternatives to HTx, however, usually only postpone the occurrence of the final end stage situation. This explains why HTx remains the last option for a substantial number of especially younger severe heart failure patients with upcoming renal failure. It is very recommendable to refer such kind of patients to university-based and specialized advanced heart failure and cardiac transplant centers, in time. This allows the introduction of optimal medical therapy, the careful medical and psychological evaluation and preparation of the considered HTx, as well as the full information procedure which has to be delivered to HTx candidates. HTx candidates should be aware about outcome numbers, medication toxicities, complications of immunosuppression, as well as the ever-present threat of cardiac allograft vasculopathy, infections and neoplasias after HTx.