Heart Transplantation: A Review of Recent Advancements in Pre-, Peri, and Post-Transplant Screening and Management

Heart transplantation (HT) remains a critical treatment for patients with end-stage heart failure who remain unresponsive to optimized guideline-directed medical therapy. This review examines recent advancements in pre-, peri-, and post-transplant screening and management aimed at improving patient selection, transplant accessibility, and clinical outcomes. Pre-transplant strategies include comprehensive HT candidate evaluation, risk stratification, donor selection, allocation policies that priotize critically ill patients, and mechanical circulatory support (MCS) to stabilize patients awaiting transplantation. Peri-transplant advances focus on strategies to maintain hemodynamic stability, minimize ischemic injury, and maintain graft viability immediately after HT. Post-transplant management emphasizes individualized immunosuppressive regimens, cardiac allograft rejection surveillance, and the prevention and management of complications to improve graft survival and long-term patient outcomes. Despite substantial progress, significant challenges remain, particularly the shortage of suitable donor organs and the risk of immune-mediated graft rejection. Emerging approaches, including artificial intelligence, xenotransplantation, and regenerative medicine, offer promising opportunities to expand the donor pool, enhance clinical decision-making, and improve HT outcomes. This review examines the research that influences the current policies and practices involved in HT, featuring the pivotal findings as well as any shortcomings present among these studies. Ultimately, continued research and multidisciplinary collaboration in each phase of HT are essential to improve the short and long-term health outcomes of transplant candidates. By integrating established evidence-based practices with emerging technologies, clinicians may further improve equitable access, survival, and quality-of-life for patients with end-stage heart failure.