Related Experiment Video
Updated: May 31, 2026
Heterotopic Cervical Heart Transplantation in Mice
Published on: August 25, 2015
Heart transplantation at the Deutsches Herzzentrum Berlin
Nicola E Hiemann1, Michael Huebler, Hans Lehmkuhl
1Deutsches Herzzentrum Berlin, Germany.
Insights
German heart transplant survival rates show similar long-term outcomes despite early challenges. This is due to a unique organ allocation system and increased use of bridge-to-transplant strategies for high-risk patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Deutsches Herzzentrum Berlin is a leading German transplant center with extensive experience in heart transplantation.
- The center has performed over 1700 heart transplants, including more than 170 in children.
- Early and intermediate survival rates are lower than international benchmarks, but long-term survival (≥15 years) is comparable.
Purpose of the Study:
- To analyze survival rates and outcomes in heart transplant recipients at the Deutsches Herzzentrum Berlin.
- To investigate the impact of Germany's organ allocation system and bridge-to-transplant strategies on patient outcomes.
- To identify key areas for improving the transplant program, including rejection screening and management of transplant-associated complications.
Main Methods:
- Retrospective analysis of heart transplant data from the Deutsches Herzzentrum Berlin.
- Comparison of survival rates with international data, particularly the ISHLT registry.
- Focus on the German organ allocation system and the bridge-to-transplant concept.
- Exploration of novel diagnostic and prognostic markers, including intramyocardial electrogram (IMEG), echocardiography, and biopsy-based characterization of microvasculopathy and Quilty lesions.
Main Results:
- Long-term survival at 15 years or more is similar to international standards.
- Discrepancies in early/intermediate survival are linked to organ shortage, a distinct German allocation system, and increased use of bridge-to-transplant for high-risk patients.
- High-risk patients, often prioritized in Germany, face greater post-transplant mortality risks.
Conclusions:
- Despite challenges related to organ shortage and allocation, long-term heart transplant outcomes in Germany are favorable.
- Future efforts should focus on non-invasive rejection screening (IMEG, echocardiography) and better characterization/management of microvasculopathy and Quilty lesions.
- Novel immunosuppressive strategies may offer therapeutic benefits and improve patient prognosis.
Abstract:
The Deutsches Herzzentrum Berlin is one of the largest transplant centers in Germany with more than 1700 transplant procedures, more than 170 being procedures in children, in patients from the beginning of life to 71 years of age. Survival rates during the early and intermediate follow-up are lower than in international data; however, long-term survival at 15 years or more is similar. Discrepant survival rates derive mainly from the organ shortage that resulted in the development of a different allocation system in Germany as compared to North America and in the increasing number of patients undergoing the bridge-to-transplant concept to move the patient to transplantability. Thus, the patient at highest risk of death while on the waiting list, who according to the ISHLT registry is also the patient at highest risk of death early post-transplant, is the candidate most likely to undergo transplantation in Germany. Unfortunately, the myth persists of solving the donor organ shortage by increasing the "fairness" of organ allocation. Major goals of our transplant program are: the introduction of non-invasive cellular rejection screening with the intramyocardial electrogram (IMEG) and echocardiography; to characterize microvasculopathy in biopsy as a novel and easily diagnosed marker for poor prognosis; to identify Quilty as a determinant for poor prognosis; to propose classifications for microvasculopathy and epicardial vasculopathy that consider the diffuse character of the disease; and to provide insights into the therapeutic options and potential clinical benefits of novel immunosuppressive strategies.
