Heart transplantation
Heart transplantation | |
---|---|
left atrium and great vessels are left in place. | |
Specialty | cardiology |
ICD-9-CM | 37.51 |
MeSH | D016027 |
MedlinePlus | 003003 |
A heart transplant, or a cardiac transplant, is a
Approximately 3,500 heart transplants are performed each year worldwide, more than half of which are in the US.[2] Post-operative survival periods average 15 years.[3] Heart transplantation is not considered to be a cure for heart disease; rather it is a life-saving treatment intended to improve the quality and duration of life for a recipient.[4]
History
American medical researcher Simon Flexner was one of the first people to mention the possibility of heart transplantation. In 1907, he wrote the paper "Tendencies in Pathology," in which he said that it would be possible one day by surgery to replace diseased human organs – including arteries, stomach, kidneys and heart.[5]
Not having a human donor heart available, James D. Hardy of the University of Mississippi Medical Center transplanted the heart of a chimpanzee into the chest of dying Boyd Rush in the early morning of Jan. 24, 1964. Hardy used a defibrillator to shock the heart to restart beating. This heart did beat in Rush's chest for 60 to 90 minutes (sources differ), and then Rush died without regaining consciousness.[6][7][8] Although Hardy was a respected surgeon who had performed the world's first human-to-human lung transplant a year earlier,[9][10] author Donald McRae states that Hardy could feel the "icy disdain" from fellow surgeons at the Sixth International Transplantation Conference several weeks after this attempt with the chimpanzee heart.[11] Hardy had been inspired by the limited success of Keith Reemtsma at Tulane University in transplanting chimpanzee kidneys into human patients with kidney failure.[12] The consent form Hardy asked Rush's stepsister to sign did not include the possibility that a chimpanzee heart might be used, although Hardy stated that he did include this in verbal discussions.[7][12][13] A xenotransplantation is the technical term for the transplant of an organ or tissue from one species to another.
Dr Dhaniram Baruah of Assam, India was the first heart surgeon to transplant a pig's heart in human body.[14] However the recipient died subsequently. The world's first successful pig-to-human heart transplant was performed in January 2022 by surgeon Bartley P. Griffith of USA.[15]
The world's first human-to-human heart transplant was performed by South African cardiac surgeon Christiaan Barnard utilizing the techniques developed by American surgeons Norman Shumway and Richard Lower.[16][17] Patient Louis Washkansky received this transplant on December 3, 1967, at the Groote Schuur Hospital in Cape Town, South Africa. Washkansky, however, died 18 days later from pneumonia.[16][18][19]
On December 6, 1967, at Maimonides Hospital in Brooklyn, New York, Adrian Kantrowitz performed the world's first pediatric heart transplant.[16][20] The infant's new heart stopped beating after 7 hours and could not be restarted. At a following press conference, Kantrowitz emphasized that he did not consider the operation a success.[21]
Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the
Worldwide, more than 100 transplants were performed by various doctors during 1968.[23] Only a third of these patients lived longer than three months.[24]
The next big breakthrough came in 1983 when cyclosporine entered widespread usage. This drug enabled much smaller amounts of corticosteroids to be used to prevent many cases of rejection (the "corticosteroid-sparing" effect of cyclosporine).[25]
On June 9, 1984, "JP" Lovette IV of
In 1988, the first "domino" heart transplant was performed, in which a patient in need of a lung transplant with a healthy heart will receive a
Worldwide, about 3,500 heart transplants are performed annually. The vast majority of these are performed in the United States (2,000–2,300 annually).
The ability of medical teams to perform transplants continues to expand. For example,
During heart transplant, the
Recently, Australian researchers found a way to give more time for a heart to survive prior to the transplant, almost double the time.[33] Heart transplantation using donation after circulatory death (DCD) was recently adopted and can help in reducing waitlist time while increasing transplant rate.[34] Critically ill patients that are unsuitable for heart transplantation can be rescued and optimized with mechanical circulatory support, and bridged successfully to heart transplantation afterwards with good outcomes.[35]
On January 7, 2022,
Contraindications
Some patients are less suitable for a heart transplant, especially if they have other
Absolute contraindications:
- Irreversible
- Active cancer if it is likely to impact the survival of the patient
- Life-threatening diseases unrelated to the cause of systemic lupus erythematosus, sarcoidosis, or amyloidosis
- Vascular disease of the neck and leg arteries.
- High pulmonary vascular resistance – over 5 or 6 Wood units.
Relative contraindications:
- Insulin-dependent diabetes with severe organ dysfunction
- Recent thromboembolism such as stroke
- Severe obesity
- Age over 65 years (some variation between centers) – older patients are usually evaluated on an individual basis.
- Active alcohol, recreational drugs or tobaccosmoking (which increases the chance of lung disease)
Patients who are in need of a heart transplant but do not qualify may be candidates for an
Complications
Potential complications include:[42]
- Acute or chronic graft rejection
- Atrial arrhythmia
- Lymphoproliferative malignancy
- Increased risk of secondary infections due to immunosuppressive medication
- Serum sickness due to anti-thymocyte globulin
- Tricuspid valve regurgitation Repeated endomyocardial biopsy can cause
- Bleeding and thrombosis [44]
Rejection
Since the transplanted heart originates from another organism, the recipient's immune system typically attempts to reject it. The risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of their life. These drugs may cause unwanted side effects, such as an increased likelihood of infections or the development of certain cancers. Recipients can acquire kidney disease from a heart transplant due to the side effects of immunosuppressant medications. Many recent advances in reducing complications due to tissue rejection stem from mouse heart transplant procedures.[45]
People who have had heart transplants are monitored in various ways to test for the development of rejection.[46]
A 2022 pilot study[47] examining the acceptability and feasibility of using video directly observed therapy to increase medication adherence in adolescent heart transplant patients showed promising results of 90.1% medication adherence compared to 40-60% typically. Higher medication variability levels can lead to fewer organ rejections and other poor outcomes.
Prognosis
The prognosis for heart transplant patients following the orthotopic procedure has improved over the past 20 years, and as of June 5, 2009 the survival rates were:[48]
- 1 year: 88.0% (males), 86.2% (females)
- 3 years: 79.3% (males), 77.2% (females)
- 5 years: 73.2% (males), 69.0% (females)
In 2007, researchers from the
See also
References
- PMID 25132976.
- ^ PMID 26793338.
- ^ a b Till Lehmann (director) (2007). The Heart-Makers: The Future of Transplant Medicine (documentary film). Germany: LOOKS film and television.
- PMID 15033856.
- .PDF), The New York Times, January 2, 1908.
- .
- ^ a b Every Second Counts: The Race to Transplant the First Human Heart, Donald McRae, New York: Penguin (Berkley/Putnam), 2006, Ch. 7 "Mississippi Gambling", pp. 123–27. This source states the heartbeat for approximately one hour.
- ^ James D. Hardy, 84, Dies; Paved Way for Transplants, Obituary, New York Times (Associated Press), Feb. 21, 2003. This source states the transplanted chimpanzee heartbeat for 90 minutes.
- PMID 14061420. in same issue.
- ^ Second Wind: Oral Histories of Lung Transplant Survivors, Mary Jo Festle, Palgrave MacMillan, 2012.
- ^ Every Second Counts, McRae, page 126, top.
- ^ PMID 22275786. ' … the consent form for Hardy's operation – which, in view of the patient's semi-comatose condition, was signed by a close relative – stipulated that no heart transplant had ever been performed, but made no mention of the fact that an animal heart might be used for the procedure. Such was the medicolegal situation at that time that this "informed" consent was not considered in any way inadequate. . '
- ^ Xenotransplantation: Law and Ethics, Sheila McLean, Laura Williamson, University of Glasgow, UK, Ashgate Publishing, 2005, p. 50.
- ^ "Pig Heart Transplanted in Human". The Hindu. 2022-01-15. Retrieved 2022-01-16.
- ^ "Man Gets Genetically Modified Pig Heart". BBC. 2022-01-15. Retrieved 2022-01-16.
- ^ a b c d McRae, D. (2006). Every Second Counts: The Race to Transplant the First Human Heart, New York: Penguin (Berkley/Putnam).
- ^ Norman Shumway: Father of heart transplantation who also performed the world's first heart-lung transplant, Obituary, The Independent [UK], 16 Feb. 2006.
- ^ "Memories of the Heart". Daily Intelligencer. Doylestown, Pennsylvania. November 29, 1987. p. A–18.
- ^ "Pneumonia Blamed in Transplant Patient's Death". The New York Times. 1967-12-21. Retrieved 2018-01-08.
- ^ Lyons, Richard D. "Heart Transplant Fails to Save 2-Week-old Baby in Brooklyn; Heart Transplant Fails to Save Baby Infants' Surgery Harder Working Side by Side Gives Colleague Credit", The New York Times, December 7, 1967. Accessed November 19, 2008.
- ^ Heart: An American Medical Odyssey, Dick Cheney, Richard B. Cheney, Jonathan Reiner, MD, with Liz Cheney, Scribner (division of Simon & Schuster), 2013. "Three days later, on December 6, 1967, Dr. Adrian Kantrowitz"
- Wikidata Q29581627.
- ^ Major Medical Milestones Leading Up To the First Human Heart Transplantation, Kate Elzinga, from Proceedings of the 18th Annual History of Medicine Days Conference 2009: The University of Calgary Faculty of Medicine, Alberta, Canada, Cambridge Scholars Publishing, 2011. " . . following Barnard's landmark heart transplantation on December 3, 1967, 107 human heart transplants were performed by 64 surgical teams in 24 countries in 1968. . "
- ^ The Adrian Kantrowitz Papers, Replacing Hearts: Left Ventricle Assist Devices and Transplants, 1960–1970, National Institutes of Health, U.S. National Library of Medicine.
- ^ Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town, South African Medical Journal, "Part I. Surgical experience and clinical studies." J Hassoulas, Vol. 102, No. 6 (2012).
- ^ "Talk About a Guy With a Lot of Heart 1st kid to get new ticker wants to be doc" NY Daily News, 13 April 2003
- PMID 21094839.
- ^ "SRTR – Scientific Registry of Transplant Recipients". www.srtr.org. Archived from the original on 2016-10-25. Retrieved 2016-10-24.
- ^ Reiner Körfer (interviewee) (2007). The Heart-Makers: The Future of Transplant Medicine (documentary film). Germany: LOOKS film and television.
- ^ First ever heart transplant in Sri Lanka successful, Hiru News, 9 July 2017.
- S2CID 235217756.
- PMID 9396446.
- ^ Woods, Emily (2021-10-11). "Donor hearts given longer life under trial". The Canberra Times. Australian Associated Press.
- S2CID 260296589.
- S2CID 218506853.
- ^ "In 1st, US surgeons transplant pig heart into human patient". Associated Press. 2022-01-10. Retrieved 2022-01-10.
- ^ "In a First, Man Receives a Heart From a Genetically Altered Pig". The New York Times. 2022-01-10. Retrieved 2022-01-10.
- ^ "Man given genetically modified pig heart dies". BBC News. 9 March 2022. Retrieved 9 March 2022.
- ISSN 0362-4331. Retrieved 2022-03-09.
- S2CID 52194404
- ^ Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 2016 Jan. 35 (1):1–23.
- PMID 30725742. Retrieved 25 June 2020 – via NCBI Bookshelf. Last Update: December 23, 2019.
- PMID 21532848.
- ^ Bishay R (2011). "The 'Mighty Mouse' Model in Experimental Cardiac Transplantation". Hypothesis. 9 (1): e5.
- PMID 20643330.
- S2CID 248242427.
- ^ Heart Disease and Stroke Statistics – 2012 Update The American Heart Association. Retrieved 27 November 2012.
- PMID 19808369.