Heart transplantation: organisational aspects and current trends in immunosuppression—a view from Spain
- Advanced Heart Failure and Transplant Unit, Cardiology Department, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
- Correspondence to Dr Javier Segovia, Cardiology Department, Hospital Puerta de Hierro Majadahonda, Madrid, Spain. C/Joaquin Rodrigo, 1. Madrid 28222, Spain;
Contributors Dr Alonso-Pulpón is the head of the group and contributed mainly to organisational aspects of heart transplantation and overall review of the manuscript. Dr Segovia wrote the main text after collecting contributions of all the authors, and prepared tables, figures, key points, and multiple choice questions. Dr Gomez Bueno contributed mainly to new trends in immunosuppression in heart transplant. Dr García-Pavía contributed mainly to classical concepts in heart transplant immunosuppression and tables 2 and 4.
- Heart transplant
- heart failure
- left ventricular assist device
- cardiogenic shock
- arrhythmogenic right ventricular dysplasia
- cardiomyopathy dilated
- cardiomyopathy hypertrophic
- cardiomyopathy restrictive
Impact and limitations of heart transplantation: organisational aspects
In spite of recent advances in the treatment of patients with end stage heart failure, heart transplantation (HTx) still remains the best option for patients under 70 years of age suffering from this condition. It provides not only a dramatic change in expected survival, unequalled by any other intervention, but also a substantial improvement in the quality of life of patients.1–3 w1
According to the Global Observatory on Donation and Transplantation, approximately 100 000 solid organ transplants are performed every year in the world, 5000 of which are HTx.3 w2 Data derived from the voluntary Registry of the International Society for Heart and Lung Transplantation (ISHLT) show that median survival after HTx is 10 years, and >90% of recipients live without significant activity limitations.2 w1 Similar results are shown in the exhaustive Spanish National Registry of Heart Transplantation (RNTC).4 In our own series of 770 HTx starting in 1984, 25% of the patients transplanted ≥20 years ago are still alive, most of them leading satisfactory, independent lifestyles.
Several factors have contributed to the positioning of HTx as a standard therapy in western countries. On the one hand, advances in the field of immunology leading to the development of drugs (ie, ciclosporin A) have allowed safe immunomodulation strategies. Acute rejection is not a major barrier to graft survival any more, and newer generation, more …