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Reviews in Cardiovascular Medicine Jan 2022The first human heart transplantation was performed by Christian Barnard in 1967. While the technical aspect had been worked out, allograft rejection was a major... (Review)
Review
The first human heart transplantation was performed by Christian Barnard in 1967. While the technical aspect had been worked out, allograft rejection was a major limitation in the early days of heart transplant. The discovery of cyclosporine revolutionized the field and led to the modern era of transplant. Heart transplantation now offers the best survival benefit for patients with end-stage heart failure with a median survival over 12 years. However, there are still limitations including the impact of limited availability of graft, graft dysfunction, and rejection, and long-term non-cardiac complications. This review serves as an update on the short- and long-term outcomes following heart transplantation focusing on the new donor allocation system, efforts to expand the donor pool, primary graft dysfunction, acute cellular and antibody-mediated rejection, cardiac allograft vasculopathy, and post-transplant malignancy and renal dysfunction.
Topics: Heart Transplantation; Humans
PubMed: 35092203
DOI: 10.31083/j.rcm2301011 -
Journal of the American College of... Mar 2020Timely referrals for transplantation and left ventricular assist device implantation play a key role in favorable outcomes in patients with advanced heart failure.... (Review)
Review
Timely referrals for transplantation and left ventricular assist device implantation play a key role in favorable outcomes in patients with advanced heart failure. Nonetheless, evaluation usually occurs at advanced heart failure centers and is obscured from referring physicians. The purposes of this review are to explain the decision-making process for candidacy for advanced therapies and to describe the potential impact of the new organ allocation algorithm on center decision making. The document first addresses the signs of advanced heart failure, specifically focusing on the importance of the syndrome of low cardiac output as a key feature of advanced heart failure, and then summarizes the evaluation as a 3-step process addressing the following questions: 1) Is transplantation or durable assist device placement indicated? 2) Are there contraindications to either intervention? 3) How can one choose between transplantation and left ventricular assist device implantation if advanced therapies are indicated and not contraindicated?
Topics: Cardiac Output; Cardiology; Clinical Decision-Making; Heart Failure; Heart Transplantation; Heart Ventricles; Heart-Assist Devices; Humans
PubMed: 32216916
DOI: 10.1016/j.jacc.2020.01.034 -
Multimedia Manual of Cardiothoracic... Jul 2023An orthotopic heart transplant remains the gold standard treatment for patients with end-stage heart failure. Despite significant developments and the widespread use of...
An orthotopic heart transplant remains the gold standard treatment for patients with end-stage heart failure. Despite significant developments and the widespread use of durable mechanical circulation support, a small number of patients will be considered for a heart retransplant. In this video tutorial, we describe the strategy and technique for patients who have already received an orthotopic heart transplant and who undergo a cardiac retransplant with a modified bicaval anastomosis technique.
Topics: Humans; Reoperation; Heart Transplantation; Anastomosis, Surgical
PubMed: 37470829
DOI: 10.1510/mmcts.2023.043 -
Current Opinion in Pediatrics Oct 2016ABO-incompatible (ABOi) heart transplantation (HTx) in young children has evolved from an experimental approach to a standard allocation option in many countries.... (Review)
Review
PURPOSE OF REVIEW
ABO-incompatible (ABOi) heart transplantation (HTx) in young children has evolved from an experimental approach to a standard allocation option in many countries. Clinical and immunological research in ABOi transplantation has revealed insight into the immature immune system and its role in superior graft acceptance in childhood and antigen-specific tolerance.
RECENT FINDINGS
Multicenter experience has confirmed equal actuarial survival, freedom from rejection, and graft vasculopathy comparing ABOi with ABO-compatible HTx. Observations of reduced antibody production and B-cell immunity toward the donor blood group have been confirmed in long-term follow-up. Mechanisms contributing to tolerance in this setting involve the interplay between B-cells and the complement system and the development of B-cell memory. Better characterization of the ABH polysaccharide antigens has improved diagnostic methods and clinical assessment of blood group antibodies. Boundaries regarding age, immune maturity, and therapeutic interventions to extend the applicability of ABOi HTx have been explored and resulted in data that may be useful for HTx patients beyond infancy and ABOi transplantation of other organs. Tolerance of ABH antigens possibly extends to HLA response.
SUMMARY
The review provides insight into the clinical evolution of ABOi HTx and associated immunologic discoveries. Current experiences and boundaries are discussed together with recent and potential future developments for utilization in other patient and age groups.
Topics: ABO Blood-Group System; Blood Group Incompatibility; Child; Child, Preschool; Graft Rejection; Graft Survival; Heart Transplantation; Humans; Infant; Infant, Newborn; Transplantation Tolerance
PubMed: 27379804
DOI: 10.1097/MOP.0000000000000398 -
Circulation Journal : Official Journal... Apr 2017Heart transplantation (HTx) is the effective way to improve quality of life as well as survival in terminal heart failure (HF) patients. Since the first heart transplant... (Review)
Review
Heart transplantation (HTx) is the effective way to improve quality of life as well as survival in terminal heart failure (HF) patients. Since the first heart transplant in 1968 in Japan and in earnest in 1987 at Taiwan, HTx has been continuously increasing in Asia. Although the current percentage of heart transplants from Asia comprises only 5.7% of cases in the International Society of Heart and Lung Transplantation (ISHLT) registry, the values were under-reported and soon will be greatly increased. HTx in Asia shows comparable with or even better results compared with ISHLT registry data. Several endemic infections, including type B hepatitis, tuberculosis, and cytomegalovirus, are unique aspects of HTx in Asia, and need special attention in transplant care. Although cardiac allograft vasculopathy (CAV) is considered as a leading cause of death after HTx globally, multiple observations suggest less prevalence and benign nature of CAV among Asian populations. Although there are many obstacles such as religion, social taboo or legal process, Asian countries will keep overcoming obstacles and broaden the field of HTx.
Topics: Asia; Cardiovascular Diseases; Endemic Diseases; Heart Failure; Heart Transplantation; Humans; Japan; Registries; Taiwan
PubMed: 28413189
DOI: 10.1253/circj.CJ-17-0162 -
Circulation. Heart Failure Dec 2022Heart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a... (Review)
Review
Heart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a contraindication to HT. Decriminalization of cannabis, increasing cannabis use, clinician biases, and lack of consensus for evaluating patients with heart failure who use cannabis all have the potential to exacerbate racial and ethnic and regional disparities in HT listing and organ allocation. Here' we review pertinent pre-HT and post-HT considerations related to cannabis use' and relative attitudes between opiates and cannabis are offered for context. We conclude with identifying unmet research needs pertaining to the use of cannabis in HT that can inform a standardized evaluation process.
Topics: Humans; Cannabis; Heart Failure; Heart Transplantation
PubMed: 36252094
DOI: 10.1161/CIRCHEARTFAILURE.122.009488 -
Heart Failure Reviews Sep 2022Cardiac transplantation is considered the gold-standard treatment option for patients suffering from end-stage heart failure refractory to maximum medical therapy. A... (Review)
Review
Cardiac transplantation is considered the gold-standard treatment option for patients suffering from end-stage heart failure refractory to maximum medical therapy. A major determinant of graft function and recipient survival is a comprehensive evaluation of the donor allograft. Challenges arise when designing and implementing an evidence-based donor evaluation protocol due to the number of influential donor-specific characteristics and the complex interactions that occur between them. Here, we present our systematic approach to donor evaluation by examining the impact that relevant donor variables have on graft function and recipient outcomes.
Topics: Heart Transplantation; Humans; Retrospective Studies; Tissue Donors
PubMed: 35118555
DOI: 10.1007/s10741-021-10178-7 -
Current Medical Science Oct 2021The purpose of this review is to provide a comprehensive update on recent advances in heart transplantation in China. Despite advances in pharmacologic and device... (Review)
Review
The purpose of this review is to provide a comprehensive update on recent advances in heart transplantation in China. Despite advances in pharmacologic and device treatment of chronic heart failure, long-term morbidity and mortality remain high, and many patients progress to endstage heart failure. Heart transplantation has become standard treatment for selected patients with end-stage heart failure, though challenges still exist. However, multiple advances over the past few years will improve the survival and quality-of-life of heart transplant recipients. This article elaborates on the specific characteristics of heart transplantation in China, the current issues, development trends, and related experiences with heart transplantation in Wuhan Union Hospital.
Topics: China; Heart Failure; Heart Transplantation; Humans; Quality of Life; Standard of Care
PubMed: 34652629
DOI: 10.1007/s11596-021-2444-9 -
Medicina (Kaunas, Lithuania) Jul 2023Heart transplantation is undergoing a continuous development, with rates of success increasing substantially due to advances in immunosuppressive therapy and surgical... (Review)
Review
Heart transplantation is undergoing a continuous development, with rates of success increasing substantially due to advances in immunosuppressive therapy and surgical techniques. The most worrying complication occurring after cardiac transplantation is graft rejection, a phenomenon that is much affected by matrix metalloproteinases (MMPs), with the role of these proteases in the cardiac remodeling process being well established in the literature. A detailed investigation of the association between MMPs and cardiac rejection is necessary for the future development of more targeted therapies in transplanted patients, and to discover prognostic serum and immunohistochemical markers that will lead to more organized therapeutic management in these patients. The aim of this review is therefore to highlight the main MMPs relevant to cardiovascular pathology, with particular emphasis on those involved in complications related to heart transplantation, including cardiac graft rejection.
Topics: Humans; Heart Transplantation; Tissue Donors; Heart; Matrix Metalloproteinases; Graft Rejection
PubMed: 37512106
DOI: 10.3390/medicina59071295 -
JACC. Heart Failure Dec 2017It has been 50 years since Dr. Christiaan Barnard performed the first human-to-human heart transplant in December 1967 in South Africa. Remarkable progress has been... (Review)
Review
It has been 50 years since Dr. Christiaan Barnard performed the first human-to-human heart transplant in December 1967 in South Africa. Remarkable progress has been made since that time, including changes in surgical techniques, immunosuppression, donor and recipient selection, and post-transplant care. In this paper, we provide a perspective on the changing face of heart transplantation and highlight key evolving areas. Topics that are covered include advances in immunosuppression, screening for acute and chronic rejection, cardiac allograft vasculopathy, and ongoing advancements in cardiac replacement therapy, including xenotransplantation, stem-cell research, tissue engineering, and the total artificial heart.
Topics: Heart Failure; Heart Transplantation; Humans; Tissue Donors
PubMed: 29191294
DOI: 10.1016/j.jchf.2017.10.009