Beyond Borders: Our Middle Eastern Experience of International Collaboration to Run a Successful Heart Transplantation Program

Introduction Heart transplantation (HT) is a highly successful management strategy for end-stage heart failure, and survival rates exceed those achieved by medical therapy. Factors such as donor availability, social and legislative boundaries limit the expansion of high volume HT programs. Methods We adopted a one-of-a-kind multicenter HT program operation in collaboration between our center in the United Arab Emirates (UAE) and 3 active HT centers in India. Patients completed their pretransplant evaluations within our program and were then sent to India to be on the HT waiting list. Once transplanted, they were sent back to the UAE where all post HT follow-up and care took place. This included surveillance endomyocardial biopsies and immunosuppression monitoring. Results Over two years, 10 HT recipients [9 males; mean age 34 yrs (range 14-62)] went through this arrangement. Fifty percent of patients were referred on inotropes and one with an LVAD. Mean waiting time was 41±8 days. Table 1 highlights baseline characteristics and table 2 summarizes our clinical outcomes after a mean follow up of 421 days. One year survival was 90%. Only one patient developed biopsy proven acute rejection requiring therapy, and 3 were found to have significant donor transmitted coronary artery disease. All patients were maintained on tacrolimus and mycophenolate mofetil, with corticosteroids tapered within the first year. The cost for HT to our patients was between $60,000 and $75,000. Conclusion International collaborations can be ideal to operate effective HT programs with excellent outcomes. Not only is this strategy is an excellent alternative while building fully independent programs, but it is also a way to overcome donor inavailability, long waiting times and inadequate financial support.