Cardiac transplantation: goals and two-year results

Results of cardiac transplantation have improved steadily following the first successful operation in 1967. However, rejection, infection, hypertension, hypercholesterolemia and accelerated coronary artery disease remain important late problems after successful heart transplantation. Facilitated patient access to the transplant center based upon geographic proximity to the home, family, and primary care physicians leads to enhanced care by allowing the original transplant team to remain actively involved with ease in the long-term follow-up. With this goal in mind, a cardiac transplantation center was developed with emphasis on developing an organized approach to providing care for patients with refractory congestive heart failure in the Virginia, West Virginia, Washington, D.C., Maryland, and Delaware area. Twenty-one of the 22 patients (95.4 per cent) survived and resumed active lives one to 26 months following heart transplantation. Forty-four rejection episodes occurred and were treated successfully, primarily on an outpatient basis. Only six infections were serious enough to require readmission to Fairfax Hospital, but all responded completely to treatment. Cardiac transplantation at a center focusing on regional patient care is not only less costly and more comfortable for patients and their families, but the continuity of care and comprehensive management of late complications can lead to improved long-term survival rates.