Clinical results of heart and heart-lung transplantation

T HE GREAT medical and social impact caused by the first human heart transplantation performed by Barnard 1 more than 20 years ago stimulated the sudden proliferation of centers performing heart transplantation. The poor results of 20% 1-year-survival rates in the late 1960s and early 1970s, 2 mainly due to early rejection and infection, rapidly discouraged this practice in practically all transplant centers. Nevertheless, notably at Stanford University, new efforts in the field of heart transplantation continued and their consistently improving survival statistics resulted in a renewed interest in heart transplantation in the late 1970s. 3 Although the first human lung transplantation was performed by Hardy 4 in 1963, 4 years prior to the first heart transplant, this clinical procedure did not achieve the same popularity as heart transplantation. In fact, little success and interest occurred in the following 20 years, during which approximately 38 patients underwent lung transplantation. Perhaps for this reason, successful thoracic organ transplantation went from cardiac to combined cardiopulmonary transplantation. The first human heart-lung transplantation was performed by Cooley 5 in 1968, and a clinical program was established at Stanford in 1981. 6 Until recently, cardiopulmonary transplantation was indicated for selected patients suffering from end-stage combined cardiopulmonary or pulmonary disease alone. With the promising clinical results obtained with single 7 and double lung g'9 transplantation, it is likely that lung disease without cor pulmonale can now be successfully managed by pulmonary transplantation alone. We present herein the current results of heart, heart-lung, and lung transplantation, discussing the options and specific needs of each patient and emphasizing the need for maximum use of organs available for transplantation. to the registry of the International Society for Heart Transplantation (ISHT), 1~ during the year 1987, 1,441 heart transplantations were performed in 109 centers in the United States with another 79 centers around the world performing approximately 700 transplants. It is estimated that each year in the United States more than 15,000 patients could benefit from heart transplantation. In contrast, each year only approximately 1,000 donor hearts are suitable for transplantation. It is clear that if not for current donor scarcity, the present experience with cardiac transplantation would be even more extensive.