Anesthetic considerations in the patient with a heart transplant.

As programs to increase the awareness of organ donation grow, more patients undergo cardiac transplantation. Because immunosuppressive therapy and postoperative care are improved, the 1-year survival rate of these patients has increased to more than 80%. Not surprisingly, these patients may, either coincidentally or as a result of medications, require other procedures using anesthesia, frequently at hospitals other than the highly specialized institution that performed the transplant. Because the denervated heart responds differently than the normal heart to many perioperative drugs, physicians, including cardiologists who are frequently consulted preoperatively, must have a special awareness of the particular problems in this group of patients.