Herztransplantation heute - ein Update

Abstract

On the third of december 1967 the first human heart transplantation was performed. During the last decades the evolution of clinical heart transplantation went from a hazardous adventure towards a safe and very successful treatment for end-stage heart failure patients. The major limiting factor is the shortage of donor organs. Patients with end-stage heart failure without any treatment options for conventional heart surgery or medical treatment are suitable candidates for heart transplantation. The major contraindication is a refractory pulmonary hypertension with a high risk for postoperative right heart failure. Due to the lack of donor organs, there is an age limitation above 65 years for the acceptance of patients in the majority of transplant centers. The distribution of donor organs is regulated by the german transplant law with eurotransplant as the executive organization. Within an acceptable cold ischemic time of 4 hours, harvesting of the donor organ, transportation and implantation of the heart has to be done. The implantation technique was developed by R. Lower and N. Shumway. In some centers, the more advanced total orthotopic heart transplantation is the technique of choice with a reduced risk of AV-valve incompetence. Postoperative treatment is very similar to standard heart surgery patients. The major difference is the immunosuppressive treatment. A balance between the risk of rejection and the risk of infection due to over immunosuppression requires an individual monitoring and tailoring of the medication. Despite the risk of heart transplantation, long term survival with one year survival greater 80 percent and 5 year survival greater than 60 percent in this particular patient group is excellent. Besides survival, quality of live and exercise capability is well restored after heart transplantation.

Literatur

• 1 Barnard C N. A human cardiac transplant: An interim report of a successful operation performed at Groote Schuur Hospital, Cape Town.  S Afr Med J. 1967;  41 1271
• 2 Lower R R, Shumway N E. Studies on the orthotopic homotransplantations of the canine heart.  Surg Forum. 1960;  11 18
• 3 Stevenson L W. Selection and management of candidates for heart transplantation.  Current Opinion Cardiol. 1996;  11 166-173
• 4 Sack F U, Kristen A, Goldschmidt H. et al . Treatment options for severe cardiac amyloidosis: heart transplantation combined with chemotherapy and stem cell transplantation for patients with AL-amyloidosis and heart and liver transplantation for patients with ATTR-amyloidosis.  European Journal of Cardio-thoracic Surgery. 2008;  33 257-262
• 5 O’Connell J B, Bourge R C, Costanzo-Nordin M R. Cardiac transplantation: Recipient selection, donor procurement, and medical follow up.  Circulation. 1992;  86 1061-1079
• 6 Dreyfus G, Jebara V, Mihaileanu A F, Carpentier A F. Total orthotopic heart transplantation: An alternative to the standard technique.  Ann Thorac Surg. 1991;  52 1181-1184
• 7 Koch A, Remppis A, Dengler T J. et al . Influence of different implantation techniques on AV valve competence after orthotopic heart transplantation.  Eur J Cardiothorac Surg. 2005;  28 717-723
• 8 Koch A, Daniel V, Dengler T J. et al . Effectivity of a T-cell-adapted induction therapy with anti-thymocyte globulin (Sangstat).  J Heart Lung Transplant. 2005;  24 708-713
• 9 Olsen S L, Wagner L E, Hammond E H. et al . Vascular rejection in heart transplantation: Clinical correlation, treatment options and future considerations.  J Heart Lung Transplant. 1993;  12 135-142
• 10 Stewart S, Fishbein M C, Snell G I. et al . Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection.  J Heart Lung Transplant. 2007;  26 1229-1242
• 11 Munksgaard B. Introduction to the guidelines.  Am J Transplant. 2004;  4 (Suppl 10) 6-9
• 12 Taylor D O, Edwards L B, Boucek M M. et al . Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth Official Adult Heart Transplant Report - 2007.  J Heart Lung Transplant. 2007;  26 769-781 Grafiken verfügbar unter http://www.ishlt.org/downloadables/heart_adult.ppt; Zugriff: Februar 2008
• 13 Gao S, Alderman E L, Schroeder J S. et al . Accelerated coronary vascular disease in the heart transplant patient: Coronary arteriographic findings.  J Am Coll Cardiol. 1988;  12 334-340
• 14 Weis M, Scheidt W von. Cardiac allograft vasculopathy.  Circulation. 1997;  96 2069-2077
• 15 Garlicki M, Wierzbicki K, Przybyłowski P. et al . The incidence of malignancy in heart transplant recipients.  Ann Transplant. 1998;  3 41-47