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Heart transplantation at Groote Schuur Hospital, Cape Town. Twenty years' experience
B A Reichart1, H C Reichenspurner, J A Odell
1Department of Cardiothoracic Surgery, University of Cape Town.
Insights
Heart transplantation outcomes have significantly improved since 1967, with a 94% 12-month survival rate achieved through evolving immunosuppressive therapies and advanced rejection monitoring techniques.
Area of Science:
- Cardiology
- Transplant Surgery
- Immunology
Background:
- Human allogeneic heart transplantation commenced in 1967.
- Over 120 heart and heart-lung transplantations performed, including retransplantations.
- Evolution of immunosuppressive protocols over decades.
Purpose of the Study:
- To review the outcomes of heart transplantation over a significant period.
- To analyze the impact of different immunosuppressive strategies on patient survival.
- To highlight advancements in organ donor management and rejection monitoring.
Main Methods:
- Categorization of patients into three immunosuppressive therapy groups (A, B, C).
- Analysis of actuarial survival rates.
- Utilisation of radionuclide scanning and endomyocardial biopsies for rejection monitoring.
Main Results:
- Significant improvement in results over the years.
- Actuarial survival rate of 94% within 12 months post-transplantation.
- Introduction of heterotopic transplantation and hormonal therapy for organ donors.
Conclusions:
- Evolving immunosuppressive regimens have enhanced heart transplant outcomes.
- Advanced monitoring techniques are crucial for managing rejection.
- Continuous innovation in transplantation procedures and donor management improves survival rates.
Abstract:
Human allogeneic heart transplantation was started at Groote Schuur Hospital in Cape Town in 1967. Since then 110 hearts (61 heterotopic and 49 orthotopic) and 12 heart-lung transplantations have been performed in the unit. Ten procedures were retransplantations including 2 third interventions. The patients fall into three groups according to their immunosuppressive therapy: group A (N = 55) from 1967 to 1982 received the so-called 'conventional treatment' (azathioprine, methylprednisolone and antithymocyte globulin (ATG)); group B (N = 15) from 1983 to 1984 received cyclosporin A in high dosage, together with methylprednisolone; and group C (N = 30) received quadruple drug therapy of low-dose cyclosporin A, together with azathioprine, methylprednisolone in lower dosages and antithymocyte globulin (for the first 4-6 days and rescue-ATG for severe rejection). The results have improved significantly over the years. The actuarial survival rate after heart transplantation within the last 12 months is 94%. Several important steps have been inaugurated: in 1973 heterotopic heart transplantation was initiated and in 1984 hormonal therapy of brain-dead organ donors was started. Radionuclide scanning, in combination with endomyocardial biopsies, has proved to be a very sensitive means of monitoring rejection.