Orthotopic heart transplantation: highlights and limitations.

A little more than three decades after the successful introduction of cardiac transplantation, this revolutionary concept of advanced heart failure treatment has gained tremendous momentum and is considered the gold standard therapy in selected patients. More specific modalities of immunosuppression continue to decrease the impact of acute and chronic rejection and immunosuppression-related side effects. The success of cardiac transplantation has led to a widespread initiation of transplant programs and a run on cardiac transplantation waiting lists. The increasing gap between waiting lists and donor organ supply has stimulated research to identify those patients who benefit most from cardiac transplantation, as well as research to develop alternative therapies for advanced heart failure. Furthermore, it serves as a stimulus to address paradigmatic issues that are fundamental to modern medicine and society.