Organization, development and early results of a heart transplant program. The Johns Hopkins Hospital experience.
Improved survival and quality of life have resulted in a resurgence in cardiac transplantation and the proliferation of centers contemplating initiation of a transplant program. Organization of such a program requires cooperation among several clinical and non-clinical departments of the hospital. Prior to implementation of such a program, a number of issues need to be addressed, including state authorization, an expeditious method for donor organ retrieval, protocols for recipient selection and evaluation, and perioperative and follow-up care of the transplant recipient. Since July of 1983, 35 patients (27 men and eight women) have undergone orthotopic cardiac transplantation. Transplantation was undertaken for cardiomyopathy (30) or end-stage ischemic heart disease (5). The mean age was 38 years (range, 16 to 57 yrs). Distant organ procurement was used for 83 percent of patients; mean ischemic time was 164 min (range, 75 to 250 min). Current immunosuppressive regimen consists of oral cyclosporine (10 mg/kg) and prednisone. Mean follow-up was 10.3 months (range, two weeks to 27 months). Transient renal dysfunction appeared early in 15 patients. Six deaths have occurred: three from rejection, one from infection, one from metastatic prostate carcinoma, and one from pulmonary hemorrhage. All but three recent patients have been rehabilitated. These initial encouraging results are a result of careful planning, institutional commitment, adequate resources and, most importantly, a dedicated transplant team.
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011182:Postoperative Care; D011788:Quality of Life; D012017:Referral and Consultation; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D014019:Tissue Donors