2. The transplanted heart
Dr. Christiaan Barnard
On December 3, 1967, 53-year-old
Lewis Washkansky* receives the first
human heart transplant at Groote
Schuur Hospital in Cape Town, South
Africa.
Approximately 2,000 transplants
performed every year in the US.
Patients are living longer and
healthier lives due to medical
advancements.
*Lewis Washkansky survived a little over two weeks after the transplantation. He succumbed to
pneumonia while being treated with an early immunosuppressive regimen.
4. Most Common Cause of Death?
Graft failure: Primary graft failure accounts for the majority of
mortality within the first 30 days after transplantation.
Opportunistic infections: Infections are the leading single cause of
death between six months to one year post-transplant.
Acute allograft rejection: Cellular and antibody-mediated rejection
within the first three years after transplantation accounts for
approximately 10 percent of deaths during this period. Thereafter,
the incidence of death related to allograft rejection declines.
Lymphoma and other malignancies
Cardiac allograft vasculopathy (CAV): The incidence of CAV
increases steadily after transplantation
5. CAV: Cardiac Allograft Vasculopathy
Cardiac Allograft Vasculopathy, Transplant Coronary Artery Disease
or Cardiac Transplant Vasculopathy
After the first year post transplantation, CAV is the second most
common cause of death after malignancy
10. Prophylaxis and Treatment
#Anti-hypertensive agents
P. McDonald et al., J. Heart Lung Transplant. 12, 80 (1993).
M. R. Mehra et al., J. Am. Cardiol. 75, 853 (1995).
J. S. Schroeder et al., N. Engl. J. Med. 328, 164 (1993).
Post-transplant hypertension develops in 60–80% of patients in the immediate
postoperative period. Several controlled trials have demonstrated a significant reduction
in CAV following treatment with calcium channel blockers but no difference in intimal
thickening following prophylactic use of ACEI. Other studies have also purported the
limited efficacy of ACEI in isolated use.
#Lipid-lowering agents
Hyperlipidemia (direct correlation with CAV) is observed in 60-80% of heart transplant
recipients. Suggested that there is a multifactorial cause, including immunosuppressive
therapy (prednisolone, cyclosporine). Treatment with statins has shown to significantly
prolong survival, especially the use of Pravastatin.
