Hanyang Med Rev.  2014 Nov;34(4):185-196. 10.7599/hmr.2014.34.4.185.

Current Status of Heart Transplantation and Left Ventricular Assist Device: Major Changes in the Last Decade

• Lee SJ
• Hong SG

• KMID: 2168351
• DOI: http://doi.org/10.7599/hmr.2014.34.4.185

Abstract

Heart transplantation is the last treatment option in refractory end stage heart failure, which can prolong survival. The number of heart transplantations has increased and the survival rate has improved during the last few decades which was contributed by advanced understanding of immunologic mechanism of rejection, pharmaceutical development and clinical management of donors and recipients. However, only a fraction of patients can be offered to transplantation due to shortage of donor heart and many patients suffer high mortality while waiting. Meanwhile, technical advancement of mechanical assist device in recent years enabled long term implantable left ventricular assist devices (LVAD) to bridge the patients with high mortality in the waiting list to transplantation and to assist as a long term destination therapy for patients who are not eligible for transplantation. Development of solid phase assay increased the sensitivity and the specificity of detection of anti-human leukocyte antigen (HLA) antibodies in the recipient. It enabled identifying unacceptable HLA antigens, acquire calculated Panel Reactive Antibodies and perform virtual cross match that can enhance the efficacy of donor allocation system to decrease the waiting time, obviate prospective cross match to decrease ischemic time and to assess the risk of rejection in presensitized patients. Antibody mediated rejection is a challenging entity in diagnosis and management. However, standardized classification of histology and immunology of endomyocardial biopsies was made recently and immunotherapy is moving toward targeted therapies directed at antibody production and function. This review focuses on those major changes in the heart transplantation field in the last decade.

Keyword

Heart Transplantation; Heart-Assist Devices; Graft Rejection

MeSH Terms

Allergy and Immunology
Antibodies
Antibody Formation
Biopsy
Classification
Diagnosis
Graft Rejection
Heart
Heart Failure
Heart Transplantation*
Heart-Assist Devices*
HLA Antigens
Humans
Immunotherapy
Leukocytes
Mortality
Sensitivity and Specificity
Survival Rate
Tissue Donors
Waiting Lists
Antibodies
HLA Antigens

Figure

• 

  Fig. 1 (A) Number of heart transplantation worldwide from the 2013 ISHLT report [1], (B) Number of heart transplantation in Korea (from presentation at APCHF 2013), (C) Number of LVAD in US from 5th IMTERMACS report [14].

• 

  Fig. 2 (A) Kaplan-Meier survival curve of heart transplantation from the 2013 ISHLT report [1], (B) Survival curve in Korea during 1992-2012 (from presentation at APCHF 2013), (C) Survival curve of continuous flow LVADs and BiVADs from 5th INTERMACS report.

• 

  Fig. 3 Proposed strategy of management of the sensitized patients [51]. *May vary among transplantation centers.

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