Cardiac transplantation at the Cleveland Clinic.

The cardiac transplant program at the Cleveland Clinic began in 1984 and has performed nearly 1,100 heart transplants. One-year actual graft and patient survival was 88% among 185 adult recipients transplanted between 1997-1999. In the past 20 years, we have seen a significant evolution of recipient selection criteria, donor suitability, immunosuppressive therapies, and posttransplant patient surveillance. Many of the changes in our program are a result of the bleak forecast, that even in a utopian situation, there would be an inadequate supply of donors. Since the potential growth in transplantable organs appears to be finite, every mechanism possible should be utilized to decrease the demand for this scarce resource. It is of utmost importance that all medical and surgical options have been exhausted prior to listing a patient for transplantation. More than 90% of our transplants are performed in patients who are UNOS Status 1A or 1B. Every patient on the waiting list must be reviewed periodically, to ensure that transplantation is still the most viable option. Finally, to reduce the risk of rejection and preserve graft survival, we must continue the search for novel immunosuppressants.