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Organization, development and early results of a heart transplant program. The Johns Hopkins Hospital experience
Insights
Cardiac transplantation is experiencing a resurgence, with careful planning and a dedicated team leading to encouraging survival rates. This study highlights the multidisciplinary approach required for successful heart transplant programs.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Cardiac transplantation is increasingly common due to improved survival and quality of life.
- Establishing a successful heart transplant program requires extensive interdepartmental cooperation.
- Key considerations include regulatory approval, organ retrieval logistics, patient selection, and comprehensive care protocols.
Purpose of the Study:
- To report on the initial outcomes of a cardiac transplantation program.
- To outline the essential components for establishing and operating a heart transplant center.
Main Methods:
- Retrospective analysis of 35 orthotopic cardiac transplant recipients between July 1983 and the study period.
- Data collected on patient demographics, indications for transplant, organ procurement details, immunosuppressive regimens, and patient outcomes.
- Follow-up care included monitoring for complications such as renal dysfunction and rejection.
Main Results:
- 35 patients (27 male, 8 female; mean age 38) underwent transplantation for cardiomyopathy or ischemic heart disease.
- Distant organ procurement was utilized in 83% of cases with a mean ischemic time of 164 minutes.
- The primary immunosuppressive regimen involved cyclosporine and prednisone; 15 patients experienced transient renal dysfunction.
- Six deaths occurred due to rejection (3), infection (1), metastatic prostate carcinoma (1), and pulmonary hemorrhage (1).
- Most patients (all but 3 recent) were successfully rehabilitated.
Conclusions:
- Careful planning, institutional commitment, adequate resources, and a dedicated transplant team are crucial for successful cardiac transplantation.
- The initial results demonstrate the feasibility and encouraging outcomes of the established heart transplant program.
- Multidisciplinary collaboration is fundamental to managing the complexities of cardiac transplant programs.
Abstract:
Improved survival and quality of life have resulted in a resurgence in cardiac transplantation and the proliferation of centers contemplating initiation of a transplant program. Organization of such a program requires cooperation among several clinical and non-clinical departments of the hospital. Prior to implementation of such a program, a number of issues need to be addressed, including state authorization, an expeditious method for donor organ retrieval, protocols for recipient selection and evaluation, and perioperative and follow-up care of the transplant recipient. Since July of 1983, 35 patients (27 men and eight women) have undergone orthotopic cardiac transplantation. Transplantation was undertaken for cardiomyopathy (30) or end-stage ischemic heart disease (5). The mean age was 38 years (range, 16 to 57 yrs). Distant organ procurement was used for 83 percent of patients; mean ischemic time was 164 min (range, 75 to 250 min). Current immunosuppressive regimen consists of oral cyclosporine (10 mg/kg) and prednisone. Mean follow-up was 10.3 months (range, two weeks to 27 months). Transient renal dysfunction appeared early in 15 patients. Six deaths have occurred: three from rejection, one from infection, one from metastatic prostate carcinoma, and one from pulmonary hemorrhage. All but three recent patients have been rehabilitated. These initial encouraging results are a result of careful planning, institutional commitment, adequate resources and, most importantly, a dedicated transplant team.