Adult heart transplantation: a general review of current strategies

ABSTRACT

Cardiac transplantation has become established as the therapeutic option of choice in the management of terminal cardiac failure. By year 2003, a cumulative total of over 70, 000 cardiac transplants have been reported from 304 cardiac transplant centers worldwide. The overall one-year and five-year survival of cardiac transplantation is 86% and 71%, respectively. The recipient factors that have a negative impact on outcome include prior transplantation, the need for a ventricular assist device or ventilator support prior to heart transplantation, a diagnosis not coronary or cardiomyopathic, and increasing age. Donor risk factors include increasing ischemic time, and donor gender and age. Infectious complications are the most common cause of death after transplantation. Cardiac allograft vasculopathy is the most common cause of death after the first year post transplantation. The most common protocol of post-transplantation treatment involves triple-drug therapy with cyclosporine, mycophenolate mofetil, and prednisone. Over 75% of patients are still on corticosteroids at 1 year post transplantation