[CARDIAC TRANSPLANTATION: REVIEW OF MANAGEMENT ISSUES AND CURRENT CHALLENGES]

Despite advances in pharmacological treatment of chronic heart failure (HF) as well as utilization of mechanical assist devices, long-term morbidity and mortality of HF patients remain high and many of these patients progress to end-stage HF. Heart transplantation has become the treatment of choice for selected patients with end-stage HF. However, challenges still exist. While the number of heart transplant candidates is increasing, the number of donors remains constant and low. Moreover, transplant candidates become older with more complex co-morbidities are at higher risk for complications such as primary graft dysfunction and rejection. A journey of heart transplantation begins far back from the day of surgery by choosing the appropriate candidate for heart transplantation and bringing him/her to the day of transplantation in the optimal condition. This process continues by matching the most favorable donor, performing organ preservation ex-vivo and coordinating the complex logistic arrangement of procurement and transplantation of the donor heart, which could take place in different hospitals. An immunosuppressive regime, which is initiated immediately after surgery, prolongs the transplant half-life on the one hand but could result in serious complications on the other hand. This review discusses post-operative issues and their management, including promising innovations that could improve the patient's long-term outcomes.