| Description |
Following animal experiments supporting the feasibility of heart transplantation, the first human heart transplant was performed in December, 1967, in Capetown, South Africa. the first successful operation in the United States was in May, 1968. Although approximately 100 transplants were performed worldwide in 1968, there were few long -term survivors. Between 1969 and the mid 1970s, only a small number of transplants were performed due to the limited ability to combat rejection and infection; the two main causes of mortallity in cardiac transplantation. By 1980, only 400 heart transplants had been done worldwide with over half of these performed at Stanford. In 1968, Stanford's one-year patient survival rate was only 22%, but by 1979 it had increased to 67%, a success rate that exceeded the expected survival of patients with end-stage heart failure 1,2. A great deal of this increased success was directly attributable to betters agents for immunosupression such as antithymocyte globulin (ATG) which added to the Stanford protocol in 1972. Also, the use of myocardial biopsy to detect early rejection allowed appropriate therapy to be initiated before overt clinical signs of rejection were seen. Prior to 1980, most centers used some combination of azathioprine, corticosteroids and ATG for immunosuppression. When Cyclosporine A (CyA) was introduced in 1980, it was perceived as a significant advancement in immunosuppressive therapy since it was thought to be both more effective and less toxic than other agents available at that time. The development of cyclosporine created renewed interest in cardiac transplantation and the field grew rapidly. According to recent figures, the number of U.S. centers increased to 74 by 1985 and more cardiac transplants were performed in the U.S. during 1980-82 than had been done in all previous years. The Utah Cardiac Transplant Program (UCTP) was started in March of 1985. As of September 1, 1986, 50 heart transplants had been performed. Although some episodes of rejection have occurred, the patient survival rate is currently 97% at one year - the best in the country. The immunosuppressive regimen has changed during this period of time with the addition of randomized trials using vincristine and Orthoclone OK13 combine with the standard regimen of cyclosporine, ATG, corticosteroids and azathioprine. In anticipation that other institutions will desire to duplicate one of these regimens, a complete descriptive analysis of the therapeutic and toxic effects of these immunosuppressive regimens is warranted. |
