Heart Transplantation: A Review

Journal of Transplant Coordination, Vol. 9, Number 1, March 1999 began to plateau in 1991. Approximately 3800 procedures are performed yearly, 2300 of them in the United States.1 The 155 US centers all compete for the static number of suitable donor hearts. However, the trend toward the acceptance of older and marginal donor hearts has not increased the number of transplants performed; the number of candidates registered for heart transplants continues to grow daily. The United Network for Organ Sharing (UNOS) currently reports that number at 4157.2 Transplant teams are challenged to physically and emotionally support the growing number of candidates who desperately await suitable organs. It is estimated that 25% of heart transplant candidates die waiting.3 The most common diagnoses in adult patients continue to be equally divided between dilated cardiomyopathy and ischemic cardiomyopathy. Survival following a heart transplant is reported to be 85% at 1 year and almost 70% at 5 years.2 Survival has improved over time: patients undergoing a transplant in the 1990s fare better than those who underwent the procedure in the 1980s.1,2 Factors associated with a positive outcome include a shorter donor-heart ischemic time, younger donor, and blood group A. Factors that increase a recipient’s risk of mortality include having preoperative mechanical ventilatory assistance or ventricular assist device (VAD), undergoing retransplantation, and being older than 65 years. Heart transplantation: a review