Tratamiento de la insuficiencia cardiaca avanzada en el siglo XXI. El trasplante cardiaco en la encrucijada

Today heart transplantation is an accepted and established treatment for advanced heart failure. However, since the first procedure in Spain was performed in 1984, there have been substantial, unfavorable changes in donor and recipient profiles, as well as in the circumstances under which patients present for transplantation. These changes have taken place in parallel with medical and surgical advances in heart transplantation, such that, overall, outcomes have not been greatly affected. Nevertheless, it is important that the number of transplantations is either maintained or increased, that the good results obtained so far are sustained, that organs continue to be allocated as fairly as possible and that mortality among patients on the waiting list is reduced. This article considers the changes that have occurred in the field and reviews proposals for future improvements.