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Heart transplantation: current practice and outlook to the future
1Service de Cardiologie, Département de Médecine Interne, Centre Hospitalier Universitaire (CHUV), Faculté Biologie et Médecine d'UNIL, Lausanne, Switzerland.
Insights
Heart transplantation survival has plateaued, necessitating a review of candidate selection and post-operative care. Future research should focus on non-immunological factors to improve long-term outcomes for heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation has advanced significantly over 40 years, with recent stagnation in long-term survival improvements.
- Changes in heart failure treatment have altered the profile of heart transplant candidates, who are now older and have more comorbidities.
Purpose of the Study:
- To review current recommendations for identifying heart transplant candidates.
- To summarize guidelines for immunological and non-immunological postoperative follow-up after heart transplantation.
Main Methods:
- This study is a review of current recommendations and literature.
- Analysis of progress in immunosuppression and heart failure treatment.
Main Results:
- Candidate evaluation requires careful consideration of age and comorbidities.
- Advances in immunosuppression have reduced acute rejection and improved survival.
- New immunosuppressive molecules are in development, promising future improvements.
Conclusions:
- The profile of heart transplant recipients has evolved due to advances in heart failure management and immunosuppression.
- Emerging immunosuppressive therapies offer new options.
- Further research is crucial to address non-immunological comorbidities and enhance long-term survival post-transplant.
Questions Under Study:
The field of heart transplantation has seen substantial progress in the last 40 years. The breakthroughs in long-term survival were followed by a period of stagnation in the last decade. This review summarises current recommendations for the identification of candidates for heart transplantation and their immunological and non-immunological postoperative follow-up.
Results:
The progress made in the treatment of patients with advanced heart failure has considerably changed the profile of candidates for heart transplantation. Patients are older, and the load of co-morbidities is more important requiring careful evaluation for candidacy. Long-standing research in the field of immunosuppression made available various drugs, which decrease the risk of acute allograft rejection and prolong survival after heart transplantation. Powerful new molecules are entering early phase clinical studies, suggesting further improvement in the near future. As a consequence, treatment of non-immunological co-morbidity after heart transplantation will gain in importance, however, the base of evidence guiding current recommendations is poor.
Conclusions:
The substantial progress in heart failure treatment and immunosuppression after heart transplantation has changed the profile of heart transplant recipients. The arrival of new molecules will provide additional alternatives for immunosuppressive treatment while studies have to address non-immunological treatment in order to improve long-term survival after heart transplantation.
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