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Madrid2009. CARDIC REPLACEMENT FOR ESHD need,supply,dreams. Professor Sir Magdi Yacoub, FRS Imperial College London Heart Science Centre. Long term outcome after Heart Transplantation. Chronology Historical perspective -need/supply Definitions “Long term”-Dreams’ Results - PowerPoint PPT Presentation
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arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Professor Sir Magdi Yacoub, FRSImperial College London
Heart Science Centre
CARDIC REPLACEMENT FOR ESHD need,supply,dreams
Madrid2009
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
Chronology
1. Historical perspective -need/supply
2. Definitions “Long term”-Dreams’
3. Results
4. The end of the beginning
5. The future
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
Historical perspectives
1. 60 years ago: fantasy for the future
2. 40 years ago: clinical introduction
a) Enthusiastic reception
b) Moratorium
c) Steady progress-massive neeed.
3. results (longtherm)
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
Definitions
Long term (DREAMS)
Expectations – moving target
- 5 year survival (cancer model)
- 10-15-20 years
- Age matched normal population
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
Results
ISHLT 2007
Transplant “half-life” = 10 years for adult And paediatric recipients
Conditional half-life for those who survive 1 year = 13 years
Constant attrition of survival 3.4% per year
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation Long Term Results
Twenty year survival
Stanford 12.5% 1968-1987
Harefield 25% 1980-1985
Fifteen year survival
Different series 20-33%
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
The end of the beginning
With maturity comes responsibility
Why only less than 12.5-25% survive 20 years
No match to general population
Constant hazard function of death of 3.4% year
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
Causes of attrition in survival and quality of life
1. Graft coronary disease
2. Malignancy 10-100 fold
3. Renal dysfunction
4. Infection
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
Long term outcome after Heart Transplantation
The Future
1. Personalized medicine (Taegtmeyer, Barton, Yacoub, Nature 2006)
2. Improving donor quality and availability (perfusion devices)
3. Early detection and treatment of rejection, cancer, renal dysfunction
4. Newer immunosuppression
5. The Holy Grail - Specific Immune Tolerance
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
The Quest for Medawar’s The Quest for Medawar’s ToleranceTolerance
Issues
Who is Medawar?
What is the Quest for Tolerance?
What have we done about it?
What does the future hold?
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
The Quest for Medawar’s The Quest for Medawar’s ToleranceTolerance
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
The Quest for Medawar’s The Quest for Medawar’s ToleranceTolerance
Isn’t he beautiful?
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
The Quest for Medawar’s The Quest for Medawar’s ToleranceTolerance
Peter Medawar - 1915-1987
1) Scientist “A tireless searcher for the truth, merciless debunker of myths”
2) “Father” of organ transplantation
3) A philosopher
4) A “humanist”
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
The Quest for Medawar’s The Quest for Medawar’s ToleranceTolerance
The Threat and the Glory
“It is the great glory as it is the great threat of science that
everything which is in principle possible can be done if the
intention to do it is sufficiently resolute.”
Peter Medawar
arefieldH O S P I T A L
Imperial CollegeOF SCIENCE TECHNOLOGY AND MEDICINE
The Quest for Medawar’s Tolerance
The Future
- Induction of Medawar’s Tolerance is badly
needed to rejuvinate tissue and organ
transplantation
- The question is how resolute is our clinical
and research community?