Middellange termijn resultaten van klinische orthotope harttransplantaties

Many clinical orthotopic heart transplant programs were initiated after the first transplantation by Barnard in 1967. Most of them were discontinued because of the high failure rate. However, in the few remaining centers the one year graft survival gradually improved, due to a more stringent patient selection, a more cautious use of immunosuppressive agents and a better management of infection complications. In 1978 a 50 - 70 % one year graft survival could be achieved with conventional immunosuppressants, including R-ATG, prednisone and azathioprine. Other factors, e.g. a better donor heart preservation and pre transplant blood transfusions, also contributed tot the improved results. An attempt is made to explain the beneficial bloodtransfusion effect. In the last part of chapter I the introduction of cyclosporine A ( CsA) in transplantation medicine is discussed. With the use of this new immunosuppressive agent an 80 %one and two year graft survival became possible in 1984. These results encouraged us to start a heart transplant program in cooperation with our colleagues in the University Hospital Leiden and the St. Antonius Hospital Nieuwegein.