HEART
TRANSPLANTATION
BINOJ DANIEL
GROUP 1
This Photo by Unknown author is licensed under CC BY-NC-ND.
HISTROY OF HEART TRANSPLANTATION
• Norman Shumway, a surgeon at Stanford University, California, had been
researching heart transplantation in animals for a decade when he
announced, on 20 November 1967, that he was ready to carry out the first
human heart transplant and was awaiting a suitable donor.
• South African surgeon Christiaan Barnard had trained with Shumway in
California, and he performed the world's first transplant on 3 December
1967. The patient survived for 17 days.
• fourth surgeon to attempt heart transplant was Dr. Prafulla Sen in Mumbai,
India on February 17, 1968
HISTROY OF CARDIAC TRANSPLANTATION
Clinical indications
• Cardiogenic shock requiring continuou
s IV inotropic support or intraaortic
balloon pump/left ventricular assist
device
• End-stage heart failure (New York
Heart Association functional class IV)
• Intractable or severe angina due
to coronary artery disease and not
amenable to other treatments
• Intractable life-threatening arrhythmias
unresponsive to other therapies
• Restrictive and hypertrophic
cardiomyopathies with heart failure
Age <55 years old
No history of chest trauma or cardiac disease cardiac donor
No prolonged hypotension or hypoxemia selection criteria
Appropriate hemodynamics
Mean arterial pressure >60 mmHg
Central venous pressure 8 to 12 mmHg
Inotropic support less than 10 mg/kg/min (dopamine or
dobutamine)
Normal electrocardiogram
Normal echocardiogram
Normal cardiac angiography (if indicated by donor age and history)
Negative serology (hepatitis B surface antigen, hepatitis C virus
and human immunodeficiency virus)
Possible Complications
• Chronic allograft vasculopathy (CAV).An accelerated type of coronary artery disease. The
blood vessels of the heart shrink and harden, reducing blood flow and possibly damaging the
heart muscle.
• Malignancies. Cancer after a heart transplant. Skin cancers and posttransplant
lymphoproliferative disorder are most common in adults, lymphoma is most common in children.
• Infection. Infection risk is highest while the patient is on immunosuppressant medications. Heart
rate life expectancy dramatically increases after immunosuppressant medication dose is lowered,
usually 1 year after surgery.
• Acute rejection. The immune system attacks the new donor heart. This most often occurs within
the first 6 months after surgery.
• Renal insufficiency. Poor blood flow to the kidneys decreases their ability to function properly.
A possible side effect of immunosuppressant medications.
Distribution of adults waiting for heart
transplant by age
Distribution of adults waiting for heart transplant
by sex.
Distribution of adults waiting for heart transplant
by diagnosis.
Distribution of adults waiting for heart transplant
by old medical urgency
Pretransplant mortality rates among adults
waitlisted for heart transplant by diagnosis.
Patient death among adult heart transplant
recipients.
Patient survival among adult heart transplant
recipients, 2013-2015, by diagnosis group
Incidence of acute rejection by 1 year posttransplant
among adult heart transplant recipients by age
Heart Transplantation in India
• Around 88% of heart transplant patients survive the first year post-surgery,
while the 5-year survival rate is 75% and 56% for 10 year survival.
• Transplantation of Human Organs Act (THOA) 1994 was enacted to provide
a system of removal, storage and transplantation of human organs for
therapeutic purposes and for the prevention of commercial dealings in
human organs.
• the national heart donation rate remained paltry at 0.14 per million
population in 2019 compared to >10 per million in the US.
REFERENCES
• OPTN/SRTR 2020 Annual Data Report: Heart M. Colvin,J. M. Smith,Y. Ahn,M. A.
Skeans,E. Messick,K. Bradbrook,K. Gauntt,A. K. Israni,J. J. Snyder,B. L. Kasiske
10 March 2022
• Kilic A, Emani S, Sai-Sudhakar CB, Higgins RS, Whitson BA. Donor selection in
heart transplantation. J Thorac Dis. 2014 Aug;6(8)
• The 2016 International Society for Heart Lung Transplantation listing criteria for
heart transplantation: A 10-year update. J Heart Lung Transplant 35:1, 2016.
• Shroff S, Mittal K, Navin S. Heart transplantation in India-looking back as we
celebrate 25 years of the transplant law. Indian J Thorac Cardiovasc Surg.
• Vaidya G. Heart transplantation in India. Indian Heart J. 2021 Jul-Aug;73(4):518-520
