Adult Cardiac Transplantation

Patients with severe drug-refractory heart failure experience one of two modes of death. Either they collapse from an arrhythmia and are deemed to have had sudden death, or they die of progressive congestive heart failure. In either instance, their poor functional status during life limits their ability to perform usual daily activities. Currently, the only proven long-term benefit to these patients is heart transplantation. The technique that led to the first human-to-human heart transplantation nearly 30 years ago has changed very little; however, refinements in post operative care have kept research in this field at the fore for many years. Immediate postoperative hemodynamic stabilization by experienced clinicians may improve a patient's chances of survival after heart transplantation. Improved immunosuppressive agents have decreased life-threatening rejection episodes. Better knowledge of the infectious diseases that attack these immunosuppressed patients has also contributed to the nearly 85% one-year survival of heart transplantation recipients. The longest surviving heart transplantation recipient remains alive and well after more than 22 years. The development of transplant-related coronary artery disease may be the only transplantation-associated factor that keeps recipients from living for many decades. Transplantation coronary artery disease leads the list of late causes of mortality. Unlike native coronary artery disease, there exists ongoing difficulty in both diagnosis and treatment of this dreaded complication. We cover current standards and future possibilities in adult heart transplantation. We look at history, demographics, indications, management, and outcome in these patients, as well as future goals.