Current Status of Heart Transplantation: the Stanford Experience

Abstract

Ten years have now passed since orthotopic transplantation of the human heart was first performed in South Africa. Since that time more than 350 cardiac transplant procedures have been carried out by 66 different transplant teams throughout the world. One hundred and forty of these operations have been performed at Stanford University. Although it is clear that cardiac transplantation has not proved to be the panacea that some early investigators had enthusiastically predicted, considerable progress has been achieved in terms of expectations for survival and rehabilitation after transplantation of the heart. This enhanced outlook has derived not from any single development, but rather from a cumulative series of improvements through the past decade. The most important of these include refinement of criteria for selection of suitable candidates for transplantation, identification of several important contraindications to transplantation, the institution of effective prophylaxis for control of coronary atherosclerosis in the cardiac allograft, recognition of the importance of fastidious surveillance of heart recipients for infection and vigorous efforts to identify and treat infectious complications without delay, routine utilization of transvenous cardiac biopsy to aid in the diagnosis and management of rejection, the use of antihuman thymocyte globulin prepared in rabbits as a powerful adjunct to standard immunosuppression, the development of various immunologic monitoring techniques for early diagnosis of rejection, and finally, retransplantation of the heart in cases of uncontrollable allograft rejection or rapidly progressive graft atherosclerosis.