Recent Advances in Cardiac Transplantation

The first decade of orthotopic heart transplantation featured the perfection of the surgical techniques, the use of immunosuppressive drugs, and the introduction of endomyocardial biopsy. Improved survival rates of 85 percent and 70 percent after one and five years, respectively, during the second decade of transplantation were directly attributable to cyclosporine, which reduced mortality from infectious complications. Despite this progress, rejection and infection remain the most important predictors of mortality during the first year after transplantation, and accelerated coronary artery disease is the chief impediment to long-term survival.1 Two socioeconomic matters — limited supplies of organs and costs — are . . .