title: 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.
authors: From the *Division of Cardiology, Department of Medicine, and †Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY.
authors: Alan L
authors: AL
authors: Gass
authors: Abbas
authors: A
authors: Emaminia
authors: Gregg
authors: G
authors: Lanier
authors: Chhaya
authors: C
authors: Aggarwal
authors: Kathy A
authors: KA
authors: Brown
authors: Maureen
authors: M
authors: Raffa
authors: Masashi
authors: M
authors: Kai
authors: David
authors: D
authors: Spielvogel
authors: Ramin
authors: R
authors: Malekan
authors: Gilbert
authors: G
authors: Tang
authors: Steven
authors: S
authors: Lansman
mesh_terms: D006085:Graft Survival / Q000502:physiology*; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000639:trends*; D006801:Humans; D011788:Quality of Life