Updates in heart transplantation.

Heart transplantation (HTx) has been a successful therapy for patients with end-stage heart failure. Since 1987, we have performed 288 HTx. Thirty-six subjects needed mechanical support prior to HTx. We use anti-thymocyte globulin (ATG) as induction therapy and low-dose immunosuppressive agents for maintenance treatment. In June 1996, we performed combined heart and kidney transplantation after bridging for 14 days with an indigenous total artificial heart (TAH). The patient is still well. Our actuarial survival rates at 1, 5, and 10 years are 86%, 76%, and 61%, respectively. One recipient who voluntarily discontinued all treatment at 4 years after HTx is still alive and free of rejection in his ninth posttransplantation year. The longest surviving recipient is in her 18th posttransplantation year. We also have used many suboptimal donor hearts, most with satisfactory outcomes. A 14-year-old boy had full recovery of heart function after receiving a donor heart after 13 hours of ischemia in 2003. Standard biatrial anastomotic technique is still our first choice. The incidence of tricuspid regurgitation (TR) and conduction disturbances is not higher than the bicaval technique reported by others. With low-dose therapy, our short-term and long-term results of HTx are satisfactory. The use of suboptimal donor hearts may expand the donor pool and save more patients' lives. A biatrial anastomosis remains our surgical technique.