General
Heart transplantation:
Indication of heart transplantation and graft survival:
Patients with cardiomyopathia, end stage coronary disease and left ventricular assist device after heart surgery are eligible for heart transplantation. Up to 20% of patients are dying on the waiting list as no suitable organ is available in time. Long-term survival rate equals results of kidney transplantation. Patient one year survival rate after heart transplantation is approximately 80%. Over 90% of them achieve a sufficient heart function and more than 70% get back to normal social life.
Donor selection, preservation, transplant procedure:
Heart allografts are obtained from post-mortem donors and preserved by usual hypothermic storage. Hearts preserved in this way do function well, if total ischemic time is limited to 4 hours. Cardiac function, size match and AB0 blood group compatibility is considered, when matching the donor heart with a potential recipient. After orthotopic placement of the heart and the anastomoses of the aortic, pulmonary artery and pulmonary veins is completed the venous return to the heart is supplied by an anastomosis of the donor and the recipients right atrium.
Complications:
New immunosuppressive therapies have reduced the risk of rejection in recent years. Cyclosporine treated recipients possess a one-year survival rate of approximately 80%. Symptoms of rejection in the initial postoperative period include fever, malaise, tachycardia and hypotension. Corticosteroids, Antithymocyte globulin (ATG) and Monoclonal Antibodies (OKT3) are the preferred treatment for severe rejection. Graft arteriosclerosis is a common side effect of cyclosporine in 25% of all heart transplantations because of increased incidence of hypertension and direct vascular toxicity. About 70% of death after transplantation is due to infection and malignancies.
