Heart transplantation at Groote Schuur Hospital, Cape Town. Twenty years' experience.
Human allogeneic heart transplantation was started at Groote Schuur Hospital in Cape Town in 1967. Since then 110 hearts (61 heterotopic and 49 orthotopic) and 12 heart-lung transplantations have been performed in the unit. Ten procedures were retransplantations including 2 third interventions. The patients fall into three groups according to their immunosuppressive therapy: group A (N = 55) from 1967 to 1982 received the so-called 'conventional treatment' (azathioprine, methylprednisolone and antithymocyte globulin (ATG)); group B (N = 15) from 1983 to 1984 received cyclosporin A in high dosage, together with methylprednisolone; and group C (N = 30) received quadruple drug therapy of low-dose cyclosporin A, together with azathioprine, methylprednisolone in lower dosages and antithymocyte globulin (for the first 4-6 days and rescue-ATG for severe rejection). The results have improved significantly over the years. The actuarial survival rate after heart transplantation within the last 12 months is 94%. Several important steps have been inaugurated: in 1973 heterotopic heart transplantation was initiated and in 1984 hormonal therapy of brain-dead organ donors was started. Radionuclide scanning, in combination with endomyocardial biopsies, has proved to be a very sensitive means of monitoring rejection.
Reichart
B A
BA
Department of Cardiothoracic Surgery, University of Cape Town.
Reichenspurner
H C
HC
Odell
J A
JA
Cooper
D K
DK
Novitzky
D
D
Human
P A
PA
Von Oppell
U O
UO
Becerra
E A
EA
Boehm
D H
DH
Rose
A G
AG
D003524:Cyclosporins / Q000627:therapeutic use; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D013019:South Africa; D014184:Transplantation, Homologous / Q000401:mortality
D003524:Cyclosporins