Transplantation for end-stage heart disease

David C. McGiffin, James K. Kirklin, James E. Davies, Spencer J. Melby

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review

Abstract

The history of cardiac transplantation is an intriguing story which started as a clinical experiment over four decades ago resulting in depressingly poor results to the point that the procedure risked abandonment as futile therapy. An era of renaissance emerged coincident with the introduction of cyclosporine-based immunosuppression evolving into an era where cardiac transplantation was regarded as the primary and “gold standard” therapy for end-stage heart disease. No doubt other factors and experience played into this development. Cardiac transplantation now, however, has entered quite a different era as a result of the considerable imbalance between the number of available donor hearts and the much greater number of potential recipients. Although long-term survival after cardiac transplantation has improved dramatically, the imperfections of current immunosuppression and the consequence of chronic rejection manifesting as coronary allograft vasculopathy continue to limit the long-term effectiveness of this therapy. In this present time, cardiac transplantation is but one of many surgical and nonsurgical alternatives for patients with end-stage heart disease. The challenge in this era is the accurate assignment of one or more therapies for an individual patient to produce the maximal benefit in terms of life expectancy and quality of life. The appropriate assignment of therapy for an individual patient is predicated upon the generation of patient-specific (which implies risk adjusted) time-related survival estimates for these various therapies, but currently the widespread application of this process remains elusive.

Original languageEnglish
Title of host publicationManagement of Heart Failure
EditorsJai Raman
Place of PublicationLondon
PublisherSpringer
Chapter4
Pages41-74
Number of pages34
Volume2
EditionSecond
ISBN (Electronic)9781447142799
ISBN (Print)9781447142782
DOIs
Publication statusPublished - 1 Jan 2016

Keywords

  • Cardiac rejection
  • Donor hearts
  • Heart transplantation
  • Immunosuppression
  • Orthotopic cardiac transplant

Cite this

McGiffin, D. C., Kirklin, J. K., Davies, J. E., & Melby, S. J. (2016). Transplantation for end-stage heart disease. In J. Raman (Ed.), Management of Heart Failure (Second ed., Vol. 2, pp. 41-74). London: Springer. https://doi.org/10.1007/978-1-4471-4279-9_4
McGiffin, David C. ; Kirklin, James K. ; Davies, James E. ; Melby, Spencer J. / Transplantation for end-stage heart disease. Management of Heart Failure. editor / Jai Raman. Vol. 2 Second . ed. London : Springer, 2016. pp. 41-74
@inbook{e040dcbe64cd4b59b8cfbd0aab346116,
title = "Transplantation for end-stage heart disease",
abstract = "The history of cardiac transplantation is an intriguing story which started as a clinical experiment over four decades ago resulting in depressingly poor results to the point that the procedure risked abandonment as futile therapy. An era of renaissance emerged coincident with the introduction of cyclosporine-based immunosuppression evolving into an era where cardiac transplantation was regarded as the primary and “gold standard” therapy for end-stage heart disease. No doubt other factors and experience played into this development. Cardiac transplantation now, however, has entered quite a different era as a result of the considerable imbalance between the number of available donor hearts and the much greater number of potential recipients. Although long-term survival after cardiac transplantation has improved dramatically, the imperfections of current immunosuppression and the consequence of chronic rejection manifesting as coronary allograft vasculopathy continue to limit the long-term effectiveness of this therapy. In this present time, cardiac transplantation is but one of many surgical and nonsurgical alternatives for patients with end-stage heart disease. The challenge in this era is the accurate assignment of one or more therapies for an individual patient to produce the maximal benefit in terms of life expectancy and quality of life. The appropriate assignment of therapy for an individual patient is predicated upon the generation of patient-specific (which implies risk adjusted) time-related survival estimates for these various therapies, but currently the widespread application of this process remains elusive.",
keywords = "Cardiac rejection, Donor hearts, Heart transplantation, Immunosuppression, Orthotopic cardiac transplant",
author = "McGiffin, {David C.} and Kirklin, {James K.} and Davies, {James E.} and Melby, {Spencer J.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1007/978-1-4471-4279-9_4",
language = "English",
isbn = "9781447142782",
volume = "2",
pages = "41--74",
editor = "Raman, {Jai }",
booktitle = "Management of Heart Failure",
publisher = "Springer",
edition = "Second",

}

McGiffin, DC, Kirklin, JK, Davies, JE & Melby, SJ 2016, Transplantation for end-stage heart disease. in J Raman (ed.), Management of Heart Failure. Second edn, vol. 2, Springer, London, pp. 41-74. https://doi.org/10.1007/978-1-4471-4279-9_4

Transplantation for end-stage heart disease. / McGiffin, David C.; Kirklin, James K.; Davies, James E.; Melby, Spencer J.

Management of Heart Failure. ed. / Jai Raman. Vol. 2 Second . ed. London : Springer, 2016. p. 41-74.

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review

TY - CHAP

T1 - Transplantation for end-stage heart disease

AU - McGiffin, David C.

AU - Kirklin, James K.

AU - Davies, James E.

AU - Melby, Spencer J.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - The history of cardiac transplantation is an intriguing story which started as a clinical experiment over four decades ago resulting in depressingly poor results to the point that the procedure risked abandonment as futile therapy. An era of renaissance emerged coincident with the introduction of cyclosporine-based immunosuppression evolving into an era where cardiac transplantation was regarded as the primary and “gold standard” therapy for end-stage heart disease. No doubt other factors and experience played into this development. Cardiac transplantation now, however, has entered quite a different era as a result of the considerable imbalance between the number of available donor hearts and the much greater number of potential recipients. Although long-term survival after cardiac transplantation has improved dramatically, the imperfections of current immunosuppression and the consequence of chronic rejection manifesting as coronary allograft vasculopathy continue to limit the long-term effectiveness of this therapy. In this present time, cardiac transplantation is but one of many surgical and nonsurgical alternatives for patients with end-stage heart disease. The challenge in this era is the accurate assignment of one or more therapies for an individual patient to produce the maximal benefit in terms of life expectancy and quality of life. The appropriate assignment of therapy for an individual patient is predicated upon the generation of patient-specific (which implies risk adjusted) time-related survival estimates for these various therapies, but currently the widespread application of this process remains elusive.

AB - The history of cardiac transplantation is an intriguing story which started as a clinical experiment over four decades ago resulting in depressingly poor results to the point that the procedure risked abandonment as futile therapy. An era of renaissance emerged coincident with the introduction of cyclosporine-based immunosuppression evolving into an era where cardiac transplantation was regarded as the primary and “gold standard” therapy for end-stage heart disease. No doubt other factors and experience played into this development. Cardiac transplantation now, however, has entered quite a different era as a result of the considerable imbalance between the number of available donor hearts and the much greater number of potential recipients. Although long-term survival after cardiac transplantation has improved dramatically, the imperfections of current immunosuppression and the consequence of chronic rejection manifesting as coronary allograft vasculopathy continue to limit the long-term effectiveness of this therapy. In this present time, cardiac transplantation is but one of many surgical and nonsurgical alternatives for patients with end-stage heart disease. The challenge in this era is the accurate assignment of one or more therapies for an individual patient to produce the maximal benefit in terms of life expectancy and quality of life. The appropriate assignment of therapy for an individual patient is predicated upon the generation of patient-specific (which implies risk adjusted) time-related survival estimates for these various therapies, but currently the widespread application of this process remains elusive.

KW - Cardiac rejection

KW - Donor hearts

KW - Heart transplantation

KW - Immunosuppression

KW - Orthotopic cardiac transplant

UR - http://www.scopus.com/inward/record.url?scp=84960319942&partnerID=8YFLogxK

U2 - 10.1007/978-1-4471-4279-9_4

DO - 10.1007/978-1-4471-4279-9_4

M3 - Chapter (Book)

SN - 9781447142782

VL - 2

SP - 41

EP - 74

BT - Management of Heart Failure

A2 - Raman, Jai

PB - Springer

CY - London

ER -

McGiffin DC, Kirklin JK, Davies JE, Melby SJ. Transplantation for end-stage heart disease. In Raman J, editor, Management of Heart Failure. Second ed. Vol. 2. London: Springer. 2016. p. 41-74 https://doi.org/10.1007/978-1-4471-4279-9_4