The Stanford experience of heart transplantation over five decades

Abstract

Aims Since 1968, heart transplantation has become the definitive treatment for patients with end-stage heart failure. We aimed to summarize our experience in heart transplantation at Stanford University since the first transplantation performed over 50 years ago. Methods and results From 6 January 1968 to 30 November 2020, 2671 patients presented to Stanford University for heart transplantation, of which 1958 were adult heart transplantations. Descriptive analyses were performed for patients in 1968–95 (n = 639). Stabilized inverse probability weighting was applied to compare patients in 1996–2006 (n = 356) vs. 2007–19 (n = 515). Follow-up data were updated through 2020. The primary endpoint was all-cause mortality. Prior to weighting, recipients in 2007–19 vs. those in 1996–2006 were older and had heavier burden of chronic diseases. After the application of stabilized inverse probability weighting, the distance organ travelled increased from 84.2 ± 111.1 miles to 159.3 ± 169.9 miles from 1996–2006 to 2007–19. Total allograft ischaemia time also increased over time (199.6 ± 52.7 vs. 225.3 ± 50.0 min). Patients in 2007–19 showed superior survival than those in 1996–2006 with a median survival of 12.1 vs. 11.1 years. Conclusion In this half-century retrospective descriptive study from one of the largest heart transplant programmes in the USA, long-term survival after heart transplantation has improved over time despite increased recipient and donor age, worsening comorbidities, increased technical complexity, and prolonged total allograft ischaemia time. Further investigation is warranted to delineate factors associated with the excellent outcomes observed in this study.

Frequency, Risk Factors, and Clinical Outcomes of Late-Onset Atrial Flutter in Patients after Heart Transplantation

“…Heart transplantation (HTX) has been considered the preferred treatment for patients with irreversible end-stage heart failure for more than 50 years [ 1 , 2 , 3 , 4 , 5 ]. As survival after HTX has continuously been improving, post-transplant clinical management is facing an increasing number of HTX recipients with chronic complications such as cardiac allograft vasculopathy, malignancy, renal dysfunction, diabetes mellitus, and cardiac arrhythmias [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

“…With over 5 decades of experience in heart transplantation, we have improved significantly on donor selection and matching. 1,6,23 Specifically, our efforts toward using organs from marginal donors have helped maximize organ allocation and decrease waitlist time without worsening patient outcomes. 10 With the advancement in organ preservation technologies, such as the SherpaPak system, we were armed with additional tools to allow us to further expand our donor pool by accepting marginal donors for select recipients from a more distant location without negatively impacting patient outcomes.…”

“…Static cold storage (SCS) of donor hearts for heart transplantation has been the conventional method of organ preservation worldwide for decades. 1 One of the most commonly used donor heart preservation techniques involves storing the organ submerged in the University of Wisconsin cold organ preservation solution 2 and then bagged to be placed in a cooler filled with slush ice. However, this conventional SCS organ preservation technique does not ensure equal cooling of the entire organ.…”

Lymph‐Node‐Targeted Drug Delivery for Effective Immunomodulation to Prolong the Long‐Term Survival After Heart Transplantation

“…Owing to the long-term pharmacologic immunosuppression as well as the side effects of immunosuppressive drugs, patients are at risk for opportunistic infections, tumors, as well as hematologic, metabolic, and nephrotoxic side effects. [30,31] Moreover, current broad-spectrum immunosuppressive approaches do not adequately prevent cardiac allograft vasculopathy. Developing more efficient targeting drug delivery systems is of critical importance for the long-term survival of patients undergoing heart transplantation.…”