Heart transplantation

Heart transplantation is the reference standard treatment for advanced acute and chronic heart failure, although limited by the scarcity of donor hearts. Careful selection of transplant candidates is therefore essential in combination with optimal donor recipient matching. In the current era, most surgeons use the bicaval heart transplant technique. Approximately half of the patients receiving a heart transplant are on mechanical circulatory support. Allograft rejection is clinically categorized according to its temporal occurrence (hyper-acute, acute, and chronic) and by the underlying mechanism (cellular, antibody-mediated, and mixed). The calcineurin inhibitors ciclosporin and tacrolimus are the cornerstones of current maintenance immunosuppression regimens and are used in combination with an anti-proliferative agent and corticosteroids to prevent rejection. The target of rapamycin inhibitors offer an alternative to chronic anti-rejection treatment. Despite the increasing complexity of heart transplant recipients, survival is improving progressively.