Heart Transplantation - Part I: General Considerations

Heart failure (HF) is a major public health problem with significant associated morbidity and mortality. In 2001, the American College of Cardiology/American Heart Association (ACC/AHA) guideline committee proposed a new approach to the classification of HF that emphasized both the development and progression of disease.  Stage A and B patients are at high risk for developing HF, and include those without structural heart disease (Stage A) and those with structural heart disease, but without signs or symptoms of HF (Stage B).  Stage C and D patients have structural heart disease with prior or current symptoms of HF (Stage C) or refractory HF requiring specialized interventions (Stage D).  Rregistries suggest that between 5% and 10% of patients with HF have advanced disease, which is associated with 1-year mortality in excess of 50% and a poor quality of life. The Heart Failure Society of America (HFSA) defines Stage D heart failure as “the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy…generally accompanied by frequent hospitalization, severely limited exertional tolerance, and poor quality of life.”  In this two-part chapter, we focus on heart transplantation, which remains the standard-of-care for highly selected patients with end-stage HF and absence of contraindications to transplant.1-5 This review contains 7 figures, 8 tables, and 46 references. Key words: heart failure, cardiomyopathy, heart transplant, mechanical circulatory support, prognosis, pulmonary hypertension, diabetes, HLA sensitization, donor