State-of-the-Art Paper
The Changing Face of Heart Transplantation

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It has been 40 years since the first human-to-human heart transplant performed in South Africa by Christiaan Barnard in December 1967. This achievement did not come as a surprise to the medical community but was the result of many years of early pioneering experimental work by Alexis Carrel, Frank Mann, Norman Shumway, and Richard Lower. Since then, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have significantly improved survival. In this article, we hope to give a perspective on the changing face of heart transplantation. Topics that will be covered in this review include the changing patient population as well as recent advances in transplantation immunology, organ preservation, allograft vasculopathy, and immune tolerance.

Key Words

heart transplantation
heart failure
immunology
cardiac surgery
coronary artery disease

Abbreviations and Acronyms

AMR
antibody-mediated rejection
CHD
congenital heart disease
CNI
calcineurin inhibitor
GEP
gene expression profiling
HLA
human leukocyte antigen
ISHLT
International Society for Heart and Lung Transplantation
MCS
mechanical cardiac support
RF
renal failure

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