Heart transplantation at the Deutsches Herzzentrum Berlin.

The Deutsches Herzzentrum Berlin is one of the largest transplant centers in Germany with more than 1700 transplant procedures, more than 170 being procedures in children, in patients from the beginning of life to 71 years of age. Survival rates during the early and intermediate follow-up are lower than in international data; however, long-term survival at 15 years or more is similar. Discrepant survival rates derive mainly from the organ shortage that resulted in the development of a different allocation system in Germany as compared to North America and in the increasing number of patients undergoing the bridge-to-transplant concept to move the patient to transplantability. Thus, the patient at highest risk of death while on the waiting list, who according to the ISHLT registry is also the patient at highest risk of death early post-transplant, is the candidate most likely to undergo transplantation in Germany. Unfortunately, the myth persists of solving the donor organ shortage by increasing the "fairness" of organ allocation. Major goals of our transplant program are: the introduction of non-invasive cellular rejection screening with the intramyocardial electrogram (IMEG) and echocardiography; to characterize microvasculopathy in biopsy as a novel and easily diagnosed marker for poor prognosis; to identify Quilty as a determinant for poor prognosis; to propose classifications for microvasculopathy and epicardial vasculopathy that consider the diffuse character of the disease; and to provide insights into the therapeutic options and potential clinical benefits of novel immunosuppressive strategies.