Cardiac transplantation: review of seven years' experience

Over the past 7 years, the feasibility of human cardiac transplantation has been documented and proved to prolong useful human life. Ideal candidates are characterized by the relatively young vigorous patient who is otherwise healthy and optimistic about his long-term chances of survival. Survival statistics indicate over a 75% 1-year survival if the patient survived the first 3 months following transplantation, at which time the most severe rejection episodes occur. Allograft rejection in both acute and chronic form remain the single most challenging problem limiting the success of the transplant program. Despite this, there has been gradual improvement in survival statistics characterized by a 57% 1-year survival for the past 1 year. The early diagnosis of cardiac rejection has been facilitated by routine serial percutaneous transvenous endomyocardial biopsies of the right ventricle to confirm clinical evidence of rejection. Over 88% of patients have been vocationally and actively rehabilitated and the remaining 12% are not limited by cardiovascular function but by complications of immunosuppresive therapy. In conclusion, it appears that human cardiac transplantation has been successful and can be used to treat selected patients with end-stage cardiac disease.