Current trends in heart transplantation

With the introduction of cyclosporin A in the early 1980s, heart transplantation was transformed from an experimental procedure into a successful therapeutic option for patients with end-stage heart disease. Since then, constant progress has extended the benefits of the procedure to an increasing number of patients. Despite all this progress, heart transplantation is not an option that can be offered to the vast majority of the world population, in particular to the over 5 billion inhabitants of underdeveloped or developing countries in the three most populated continents, namely, Asia, Africa and South America. While the North American continent and Europe account for only 17% of the world population, they donate and receive over 95% of the heart transplants performed worldwide. In addition, the number of transplant candidates continues to exceed the number of available donors, and the donor shortage is not expected to improve. Opportunistic infections, rejection, malignancy and graft coronary artery disease continue to plague heart transplantation and remain the Achilles heel of the procedure. With the beginning of the new millennium, new perspectives are arising in heart transplantation. Strategies addressing donor-specific tolerance and the development of selective immunosuppressive therapies are on the horizon and could improve the quality of life after transplantation and also prolong survival. Copyright (C) 2004 S. Karger AG, Basel.