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Heart transplantation: review
Sandrigo Mangini1, Bárbara Rubim Alves1, Odílson Marcos Silvestre2
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Insights
Heart transplantation is the best treatment for severe heart failure. Donor shortages are a challenge, but mechanical support devices and increasing donors in Brazil offer hope for more successful transplants.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Devices
Background:
- Heart transplantation is the gold standard for refractory heart failure.
- Donor scarcity limits transplant numbers, increasing reliance on mechanical circulatory support.
- Established protocols exist for transplant management and rejection treatment.
Purpose of the Study:
- To review the current status and future potential of heart transplantation.
- To discuss challenges like donor shortages and waiting list mortality.
- To highlight opportunities for improving heart transplant outcomes in Brazil.
Main Methods:
- Review of current literature on heart transplantation.
- Analysis of challenges and advancements in mechanical circulatory support.
- Evaluation of donor availability and strategies for increasing effective donors.
Main Results:
- Heart transplantation offers favorable outcomes when managed with established protocols.
- Early complications include graft failure, RV dysfunction, rejection, and infections.
- Late complications involve cardiac allograft vasculopathy and neoplasms.
Conclusions:
- Despite challenges, heart transplantation remains a vital treatment for end-stage heart failure.
- Brazil has significant potential to increase donor numbers and utilize circulatory assist devices.
- Optimizing these factors can improve the volume and success rates of heart transplants in Brazil.
Abstract:
Heart transplantation is currently the definitive gold standard surgical approach in the treatment of refractory heart failure. However, the shortage of donors limits the achievement of a greater number of heart transplants, in which the use of mechanical circulatory support devices is increasing. With well-established indications and contraindications, as well as diagnosis and treatment of rejection through defined protocols of immunosuppression, the outcomes of heart transplantation are very favorable. Among early complications that can impact survival are primary graft failure, right ventricular dysfunction, rejection, and infections, whereas late complications include cardiac allograft vasculopathy and neoplasms. Despite the difficulties for heart transplantation, in particular, the shortage of donors and high mortality while on the waiting list, in Brazil, there is a great potential for both increasing effective donors and using circulatory assist devices, which can positively impact the number and outcomes of heart transplants.
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