[Heart transplantation--status and perspectives].

Transplantation of the heart (HTx) has become a realistic procedure in the treatment of terminal cardiac failure. However, several problems remain and are to be discussed on the basis of our experience in 160 cases of HTx. A dramatic widening of indications for HTx presently is not to be expected while the lack of donor organs is magnified by the growing transplantation frequency. This bottle neck only can be lessened by mobilization of all organ sources. Longterm survival rate in HTx patients seems to stabilize at well over 70%. Persisting mortality and morbidity of HTx are the result of imperfect recognition and treatment of rejection as well as infection. The use of circulatory aids in patients expecting HTx and in those with a failing transplant is of growing importance at the same time posing the problem of high urgency in patients thus instrumented. It is likely that the intermediate-term use of the totally implantable artificial heart will lessen this dilemma. Costs and efforts of cardiac transplantation are considerable. A plea therefore is made for concentration of organ transplantations of all types in special centers.