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 …