Cardiac Transplantation in the New Era

Abstract

The prevalence of heart failure continues to rise due to the aging population and longer survival of people with conditions that lead to heart failure, eg, hypertension, diabetes, and coronary artery disease. Although medical therapy has had an important impact on survival of patients and improving quality of life, heart transplantation remains the definitive therapy for patients that eventually deteriorate. Since the first successful heart transplantation in 1967, significant improvements have been made regarding donor and recipient selection, surgical techniques, and postoperative care. However, the number of potential organ donors has not changed and the growing number of patients in need for transplantation has resulted an increase in waiting list time, and the need for mechanical support. To overcome this issue, the United Network for Organ Sharing implemented an allocation system to prioritize the sickest patients on the list to receive organs. Despite the careful selection of patients, pretransplant immunological screening, and multidrug immunosuppressive regimens, acute and chronic rejections occur and potentially limit graft and patient survival. Treatment for rejection largely depends on the type of rejection, the presence of hemodynamic compromise, and time after transplantation. The limiting factor for long-term graft survival is allograft vasculopathy, an immune-mediated process causing diffuse narrowing of the coronary arteries. Percutaneous coronary intervention and coronary artery bypass surgery are often not an option for this vasculopathy due to the lack of focal lesions, and retransplantation is the only option in appropriate patients.

Mesenchymal Stem/Stromal Cell-Based Therapy for Heart Failure ― What Is the Best Source? ―

“…In the 1970 s, Friedenstein et al first reported a rare population of plastic-adherent, fibroblast-like, and colony-forming BMCs with a high replicative capacity, which are now commonly referred to as MSCs. 17 The basic protocol for collecting BM-MSCs from the product of bone marrow aspiration includes the following 3-step process: (1) separation of nucleated cells from nonnucleated cells by density gradient centrifugation, (2) adherence of cells to plastic tissue culture flasks, and (3) passaging of adhered MSCs. 18 BM-MSCs are reported to have the capacity for cardiomyogenic differentiation in vitro, 19 in which bone morphogenetic protein (BMP)-2, fibroblast growth factor (FGF)-2, hepatocyte growth factor (HGF), insulin-like growth factor (IGF)-1, and transforming growth factor (TGF)-β1 play a role.…”

Past and Present of Total Artificial Heart Therapy: A Success Story

“…Considering the progressive nature of the disease, more and more patients in the less severe stages will eventually end up in the D category. These are sobering facts considering the limited treatment options for such patients, for whom heart transplantation has long been considered the optimal salvation [ 5 , 6 ]. However, the paucity of available donors, much less the dysfunction of almost 60% of donated hearts, is a major hurdle impeding attempts to save the lives of these patients by means of transplantation [ 7 , 8 ].…”

Stem Cells in Cardiovascular Medicine: Historical Overview and Future Prospects

“…Howbeit, due to the progressive nature of CVDs, heart failure (HF) is, in most cases, inevitable [5]. Regardless of etiology and severity, many end-stage HF patients will eventually need cardiac transplantation [6]. With very few treatment options, not to mention the paucity of available donor hearts, the need for alternative therapeutic measures is indispensable.…”