Cardiac Transplantation for Pediatric and Congenital Cardiac Disease
History of Cardiac Transplantation
The first successful heart transplant was performed by Christian Barnard in South Africa on December 3, 1967. This clinical success was based on experimental work done by Richard Lower and Norman Shumway at Stanford. During the next year, over 100 cardiac transplants were performed around the world. Unfortunately, most of the patients died of either allograft rejection or overwhelming infection. The introduction of percutaneous transvenous right ventricular endomyocardial biopsy (1972) and a standardized grading system for cardiac rejection (1974) were developed by the team at Stanford., These advances, along with the introduction of cyclosporine, led to improved survival and acceptable outcomes.
Incremental improvements in outcomes after cardiac transplantation have resulted from multiple advances:
- the introduction of percutaneous transvenous right ventricular endomyocardial biopsy (1972),
- a standardized grading system for cardiac rejection (1974),
- the introduction of cyclosporine,
- use of the bicaval technique,
- tacrolimus (FK506) immunosuppression,
- steroid free immunosuppression, and
- induction therapy with monoclonal antibodies.
Infant cardiac transplantation was first successfully performed by Dr. Leonard Bailey at Loma Linda University on November 20, 1985. This followed attempts at clinical Xenotransplantation by the Loma Linda group. A major advance occurred with the introduction of ABO incompatible cardiac transplantation for infants in 2001, allowing expansion of the donor pool. Currently, infant and pediatric cardiac transplantation accounts for 10% of all cardiac transplants.
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