Heart Transplantation Following Mechanical Circulatory Support Longer Than Two Years
Satoshi SaitoHironori MurakamiYouji TakiguchiTakeshi KatsubeMinojri TateishiNobuhiro UmeharaShinichi NunodaKenji Yamazaki
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Heart transplantation is in its third decade as a widely accepted treatment for advanced heart failure. What is its prognosis? In the early era of heart transplantation, the perceived alternative to transplantation was imminent death. In 1968, at the beginning of heart transplantation, Peter Medawar, the eminent zoologist and Nobel laureate whose work on tolerance set the scene for successful transplantation, correctly predicted: “The transplantation of human organs will be assimilated into ordinary clinical practice … and there is no need to be philosophical about it. This will come about for the single and sufficient reason that people are so constituted that they would rather be alive than dead.”1
Heart transplantation has a high early mortality—15-20% of recipients die within a year of the operation. 2 3 Thereafter the death rate is constant, at about 4% a year for the next 18 years, so that 50% of patients can expect to be alive after 10 years and 15% after 20 years. Application of heart transplantation has been based almost entirely on doctors' …
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Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.
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In 1905, Carrel and Guthrie reported the heterotopic heart transplantation on dogs for the first time. In the same year, Shone advanced the transplantation immunity theory which provided a basis for organ transplantation. In 1964, Hardy and his colleagues performed the first human chimpanzee heart transplantation. In 1967, Barnard performed the first human-to-human orthotopic heart transplantation in the world. In 1968 - 1971, 56 hospitals performed 180 heart transplantations world-wide. But because of the poor survival rate after operation, heart transplantations became less frequent. In 1972, Castaneda and Reitz summed up the experiences of heart-lung experimental transplantation, which laid a foundation for human heart-lung transplantation. In 1973, Caves invented myocardium biopsy for rejection surveillance after heart transplantation, which solved the problem of diagnosis for early rejection. In 1981, Stanford University first took cyclosporin A into clinical practice. The acute rejection after heart transplantation was effectively controlled and the long-term survival rate was significantly increased. Heart transplantation entered the second peak period. The launching of Asian heart transplantation began in 1968. Juro·Wada with his medical team performed the first heart transplantation in Japan. In 1978, Zhang Shize in Shanghai performed the first heart transplantation in China.
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Between February 1984 and December 1987, 63 patients were accepted as candidates for heart transplantation. Eighteen patients (29%) required some form of mechanical circulatory support before transplantation; eight patients received an intraaortic balloon pump, five patients had left ventricular assist devices, two patients received biventricular assist devices, and in three patients the total artificial heart was implanted. Fourteen of the 18 patients underwent transplantation with seven longterm survivors.
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