The Heart Transplant: Eleven-Year Progress Report

Abstract

Cardiac transplantation was introduced as a therapeutic procedure 12 years ago. More than 400 cardiac transplant operations have now been performed by 68 units throughout the world. After the initial enthusiasm for transplantation in 1968 and 1969, realization of the immense challenges and obstacles to a successful outcome and the generally low survival rates achieved resulted in the abandonment of transplantation in all but a few centers. At Stanford University Medical Center, an active clinical program in heart transplantation was initiated in 1968 and has continued. By August 1980, a total of 212 cardiac transplant operations had been performed in 194 patients, with 74 patients then surviving. Changes in the management of cardiac transplant recipients over the past 10 years have resulted in a substantial improvement in the outlook for survival. Imuran and prednisone remain the primary immunosuppressive agents, but rabbit antithymocyte globulin is used initially and reinstituted during rejection. Endomyocardial biopsy has allowed more precise diagnosis and management of rejection, and, more recently, immunologic monitoring has been introduced to provide more frequent assessment of the host immune response. Infection is the major cause of death, and its diagnosis and treatment is managed aggressively. Current survival figures justify the use of cardiac transplantation in an experienced unit when other measures have been exhausted in the treament of terminal cardiac failure.