Advances in Cardiac Transplantation

There have been several advances in cardiac transplantation, but some problems remain. A major hurdle to long-term graft survival is the problem of chronic rejection or graft atherosclerosis which occurs in 30% to 60% of transplant patients within five years. In the Western world a significant imbalance between demand and supply for heart transplants exists; as a consequence, over 20% of patients awaiting a heart transplant die before receiving an organ. In xenotransplantation, over the last five years, there has been significant progress in the understanding ofthe mechanism of hyperacute rejection, the role of endothelium, and genetic engineering. The long-standing barrier of hyperacute rejection in xenotransplantation appears to have been conquered. Current focus is on the control of delayed xenograft rejection, and several approaches including the use of anti platelet, immunosuppressive and/or anti-inflammatory agents are being studied. It appears that genetic engineering may have been a significant role in this control.