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Review
. 2014 May 1;4(5):a015636.
doi: 10.1101/cshperspect.a015636.

Heart transplantation: challenges facing the field

Makoto Tonsho  1 , Sebastian Michel, Zain Ahmed, Alessandro Alessandrini, Joren C Madsen
Affiliations
Review

Heart transplantation: challenges facing the field

Makoto Tonsho et al. Cold Spring Harb Perspect Med. .

Abstract

There has been significant progress in the field of heart transplantation over the last 45 years. The 1-yr survival rates following heart transplantation have improved from 30% in the 1970s to almost 90% in the 2000s. However, there has been little change in long-term outcomes. This is mainly due to chronic rejection, malignancy, and the detrimental side effects of chronic immunosuppression. In addition, over the last decade, new challenges have arisen such as increasingly complicated recipients and antibody-mediated rejection. Most, if not all, of these obstacles to long-term survival could be prevented or ameliorated by the induction of transplant tolerance wherein the recipient's immune system is persuaded not to mount a damaging immune response against donor antigens, thus eliminating the need for chronic immunosuppression. However, the heart, as opposed to other allografts like kidneys, appears to be a tolerance-resistant organ. Understanding why organs like kidneys and livers are prone to tolerance induction, whereas others like hearts and lungs are tolerance-resistant, could aid in our attempts to achieve long-term, immunosuppression-free survival in human heart transplant recipients. It could also advance the field of pig-to-human xenotransplantation, which, if successful, would eliminate the organ shortage problem. Of course, there are alternative futures to the field of heart transplantation that may include the application of total mechanical support, stem cells, or bioengineered whole organs. Which modality will be the first to reach the ultimate goal of achieving unlimited, long-term, circulatory support with minimal risk to longevity or lifestyle is unknown, but significant progress in being made in each of these areas.

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Figures

Figure 1.
Figure 1.
Heart versus kidney transplantation in MHC class I disparate swine treated with a 12-d course of CyA.
Figure 2.
Figure 2.
Hypothetical models explaining kidney-induced cardiac allograft tolerance.
Figure 3.
Figure 3.
Hypothetical models explaining the spontaneous acceptance of liver allografts.
See this image and copyright information in PMC

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