Cardiac transplantation.

With the advent of cyclosporine and triple-drug therapy, cardiac transplantation has developed from a curiosity into an effective therapy. Optimal results require proper recipient selection, careful donor identification and preparation, and skillful surgical and postoperative care. Recent trends to expand the donor and recipient pools will result in an amplification of the problems encountered to date. Causes of significant perioperative morbidity and mortality continue to be graft failure, infection, and rejection. Careful attention to elevated recipient pulmonary vascular resistance and donor heart preservation are essential to prevent graft failure. Diagnosis and treatment of infection and rejection depend on anticipation and vigilance by the cardiac transplant team. Knowledge of and familiarity with immunosuppressive regimens and the inherent side effects, both unique to each drug and common to the group, should enable minimization of the drugs' toxicities. Long-term sequelae of cardiac transplantation are now being defined and our ability to affect them is a continuing challenge. Cardiac transplantation has become a safe and effective treatment for end-stage cardiovascular disease. Success is now measured, not by patient survival, but by the quality of life achieved by those who receive this treatment modality.