History of Heart Transplant
Cardiac transplantation represents the gold standard therapy for patients with advanced heart failure refractory to medical and device therapy. Decades of clinical and animal-based research laid the foundation for the first heart transplant performed on D
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History of Heart Transplant Nina Badoe and Palak Shah
Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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The Pre-clinical Era . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Clinical Cardiac Transplantation: The Early Days of Heart Transplant in Humans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Orthotopic Human Heart Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Understanding the Immune System and Allograft Monitoring . . . . . . . . . . . . . . . . . . . . .
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Immunosuppression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Abstract
Cardiac transplantation represents the gold standard therapy for patients with advanced heart failure refractory to medical and device therapy. Decades of clinical and animal-based research laid the foundation for the first heart transplant performed on December 3, 1967, by Christiaan Barnard in Cape Town, South Africa. The initial enthusiasm for transplantation spread quickly
N. Badoe Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA e-mail: [email protected] P. Shah (*) Department of Heart Failure and Transplant, Inova Heart and Vascular Institute, Falls Church, VA, USA e-mail: [email protected]
and about 100 transplants were performed in the year that followed 1967. Early immunosuppressive regimens consisted of steroids and azathioprine. Early on, due to unthwarted and often undiagnosed rejection, 1-month mortality after cardiac transplant exceeded 50% and most centers abandoned the procedure by 1970. In 1972, Phillips Caves developed the technique for an endomyocardial biopsy and together with Margaret Billingham developed objective criteria for the histopathologic assessment of allograft rejection. Norman Shumway pioneered the use of a calcineurin inhibitor, cyclosporine as a more potent immunosuppressive agent to mitigate rejection after cardiac transplantation. With the successful incorporation of cyclosporine, short and intermediate-term survival improved dramatically and between 1980 and 1990, the
© Springer Nature Switzerland AG 2020 L. Bogar, A. Stempien-Otero (eds.), Contemporary Heart Transplantation, Organ and Tissue Transplantation, https://doi.org/10.1007/978-3-319-58054-8_1
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N. Badoe and P. Shah
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