[Treatment and follow-up care after heart transplantation]

Today survival rates after heart transplantation of around 80% at 1 year and around 65% at 5 years are realistic. Most patients attain NYHA functional class I. Due to progress in donor and recipient selection, in immunotherapy, and in a systematic follow-up program post transplant, heart transplantation today has become an accepted treatment in special forms of terminal heart disease. Between September 23, 1985, and May 15, 1987, 19 patients were transplanted in Zurich. After an average of 7 months (1-20), 18 patients are alive with NYHA functional class I. The follow-up program checks systematically for the three main problems post transplant (rejection, infection, and drug-induced side-effects). Regular endomyocardial biopsy is the gold standard for diagnosis of rejection. Non-invasive methods, such as cyto-immunological monitoring, neopterin, or beta 2-microglobulin, are not a substitute but valuable adjunctive diagnostic methods.