Heart Transplant

About Heart Transplant

Heart transplantation replaces a failing heart with a healthy donor heart and is the established treatment for selected patients with end stage heart failure that does not respond to other therapies. The first human heart transplant was performed by Christiaan Barnard in Cape Town, South Africa, in 1967. Early results were poor because of rejection, and the procedure became widely adopted only after the introduction of the immunosuppressant cyclosporine in the early 1980s. Common underlying conditions include ischemic cardiomyopathy, dilated cardiomyopathy, congenital heart disease and some forms of valvular and restrictive heart disease. Candidates undergo extensive medical and psychosocial evaluation, and donor hearts are allocated according to blood group, body size, medical urgency and distance, because the heart tolerates only a limited time outside the body. Newer preservation systems that keep the donor heart beating and perfused outside the body are extending this window and allow use of hearts donated after circulatory death. In the operation, the recipient is placed on cardiopulmonary bypass, the diseased heart is removed and the donor heart is connected using bicaval or biatrial techniques. Ventricular assist devices are often used as a bridge to transplantation. Lifelong immunosuppression, typically combining several drug classes, is needed to prevent rejection, and biopsies of the heart muscle are used to detect it. Long term complications include cardiac allograft vasculopathy, a form of chronic rejection affecting the coronary arteries, as well as infections, kidney damage and cancers related to immunosuppression. Many recipients live for well over a decade after transplantation.