Heart Transplantation: A Review of Evolution, Current Status, and Persistent Challenges

Heart transplantation (HTx) remains the gold-standard therapy for select patients with end-stage heart failure, offering significant improvements in survival and quality of life. Since its clinical introduction in 1967 in South Africa by Christiaan Barnard, advancements in surgical techniques, immunosuppressive regimens, and posttransplant care have improved 1-year survival rates from 81% before the year 2000 to over 90%. However, long-term survival is still limited by formidable complications such as chronic rejection, most notably cardiac allograft vasculopathy, malignancy, and the nephrotoxic effects of chronic immunosuppression. This review outlines the historical milestones, current clinical practice, including patient selection and immunosuppression, and discusses the major challenges that continue to drive research in the field.