Morning ReportPATRICK SANDIFORD, 3/3/2014

The transplanted heart

On December 3, 1967, 53-year-old Lewis Washkansky* receives the first human heart transplant at Groote Schuur Hospital in Cape Town, South Africa.

Dr. Christiaan Barnard

Approximately 2,000 transplants performed every year in the US. Patients are living longer and healthier lives due to medical advancements.

*Lewis Washkansky survived a little over two weeks after the transplantation. He succumbed to pneumonia while being treated with an early immunosuppressive regimen.

Heart Transplant Patients

ISHLT is a great resource to learn more about heart and lung transplantation

Most Common Cause of Death?

Graft failure: Primary graft failure accounts for the majority of mortality within the first 30 days after transplantation.

Opportunistic infections: Infections are the leading single cause of death between six months to one year post-transplant.

Acute allograft rejection: Cellular and antibody-mediated rejection within the first three years after transplantation accounts for approximately 10 percent of deaths during this period. Thereafter, the incidence of death related to allograft rejection declines.

Lymphoma and other malignancies

Cardiac allograft vasculopathy (CAV): The incidence of CAV increases steadily after transplantation

CAV: Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy, Transplant Coronary Artery Disease or Cardiac Transplant Vasculopathy

After the first year post transplantation, CAV is the second most common cause of death after malignancy

CAV vs. Typical Atherosclerosis

Screening?

Coronary angiography, performed annually or biannually,remains the most common clinical screening method

Conventional coronary angiography vs. intravascular ultrasound in the measurement of flow to indicate significant disease

Echocardiogram: minimal vs. severe CAV

Prophylaxis and Treatment

#Anti-hypertensive agents

Post-transplant hypertension develops in 60–80% of patients in the immediate postoperative period. Several controlled trials have demonstrated a significant reduction in CAV following treatment with calcium channel blockers but no difference in intimal thickening following prophylactic use of ACEI. Other studies have also purported the limited efficacy of ACEI in isolated use.

#Lipid-lowering agents

Hyperlipidemia (direct correlation with CAV) is observed in 60-80% of heart transplant recipients. Suggested that there is a multifactorial cause, including immunosuppressive therapy (prednisolone, cyclosporine). Treatment with statins has shown to significantly prolong survival, especially the use of Pravastatin.

P. McDonald et al., J. Heart Lung Transplant. 12, 80 (1993).

M. R. Mehra et al., J. Am. Cardiol. 75, 853 (1995).

J. S. Schroeder et al., N. Engl. J. Med. 328, 164 (1993).

Thanks!