Trends and outcomes in heart transplantation: the Berlin experience

R Hetzer, E M Delmo Walter, R Hetzer, E M Delmo Walter

Abstract

Heart transplantation is an established procedure with acceptable, predictable long-term results and good quality of life for more than 20 years. However, it is only available for a limited number of patients. The fate of the patients is determined by the side effects of immunosuppressive drugs, increased tumor incidence and chronic vascular transplant disease. Patients living 10 to 20 years after heart transplantation show physical status equal to that of patients with various chronic illnesses. They suffer from chronic side effects of long-term medication and mainly report fears of renal insufficiency followed by osteoporosis-associated pain, cortisone-induced myopathy and risk for tumors. Only moderate psychological impairment is reported despite somatic problems. In the period 10-20 years post-heart transplantation, there is even a surprising increase in emotional well-being. The 20-year survivors are active and satisfied with daily life. They experience their own life as meaningful and have good partner, family and social relations. Heart transplantation, the most ambitious project in medicine in the 20th century has been made a reality. Its development has the strongest impact on cardiac surgery, immunology, pharmacology, medical logistics, defining life and death, ethics in medicine, acceptance of medical progress by the public and by health care systems. It has provided a strong solidarity among politicians, sociologists, physicians and citizens. Ethical concerns will last and will make heart transplantation an important, yet temporary episode in human medicine. It has stimulated research and development of mechanical circulatory support systems as an alternative to treat end-stage heart failure.

Keywords: congenital heart diseases; heart transplantation; immunosuppression; mechanical circulatory support devices; rejection.

Conflict of interest statement

Disclosures None declared

References

    1. Barnard C N. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J. 1967;41:1271–1271.
    1. Kantrowitz A, Haller J D, Joos H. et al. Transplantation of the heart in an infant and an adult. Am J Cardiol. 1968;22:782–790.
    1. Hetzer R, Potapov E, Müller J. et al. Daily non-invasive rejection monitoring improves long-term survival in pediatric heart transplantation. Ann Thorac Surg. 1998;66:1343–1349.
    1. Warnecke H, Schüler S, Goetze H J. et al. Noninvasive monitoring of cardiac allograft rejection by intramyocardial electrogram recordings. Circulation. 1986;74:72–76.
    1. Hiemann N, Wellnhofer E, Knosalla C. et al. Prognostic impact of microvasculopathy on survival after heart transplantation: evidence from 9713 endomyocardial biopsies. Circulation. 2007;116:1274–1282.
    1. Zuppan C W, Wells L M, Kerstetter J C. et al. Cause of death in pediatric and infant heart transplant recipients: review of a 20 year, single-institution cohort. J Heart Lung Transplant. 2009;28:579–584.
    1. Schubert S, Abdul-Khaliq H, Lehmkuhl H B. et al. Diagnosis and treatment of post-transplantation lymphoproliferative disorder in pediatric heart transplant patients. Pediatric Transplantation. 2009;13:54–62.
    1. Hennig E. 1991. Design criteria for pediatric mechanical circulatory support systems (PMCSS). pp. 30–43. [In Ferrazzi P, Parenzan L. eds. Annals of the concerted\\action HEART 1991-1992. Bergam, Italy. Commission of the European Communities]
    1. Warnecke H, Berdjis F, Hennig E. et al. Mechanical left ventricular support as a bridge to transplantation in childhood. Eur J Cardiothorac Surg. 1991;5:330–333.
    1. Christie J D, Edwards L B, Kucheryavaya A Y. et al. The registry of the international society for heart and lung transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant. 2012;31:1073–1086.
    1. Hetzer R, Albert W, Hummel M. et al. Status of patients presently living 9-13 years after orthotopic heart transplantation. Ann Thorac Surg. 1997;64:1661–1668.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj