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Review
. 2025 Sep 26;14(19):6805.
doi: 10.3390/jcm14196805.

Heart Transplant: A Never-Ending Story

Daniele Masarone  1 , Rita Gravino  1 , Luigi Falco  1 , Dario Catapano  1 , Cristiano Amarelli  2 , Angelo Caiazzo  2 , Claudio Marra  2 , Michelle Kittleson  3 , Pierino Di Silverio  4 , Emilio Di Lorenzo  1
Affiliations
Review

Heart Transplant: A Never-Ending Story

Daniele Masarone et al. J Clin Med. .

Abstract

Despite ongoing advancements in the field of heart failure, heart transplantation remains the definitive treatment for patients with advanced heart failure. Decades of research, surgical innovation, and progress in transplant immunology have enabled the overcoming of persistent challenges associated with this complex procedure. Since the initial preclinical experiments involving heart transplants in canines and primates, the process has been profoundly transformed through the development of the bioptome for endomyocardial biopsies and the introduction of immunosuppressive therapies. More recently, improvements in the preservation and transportation of donor hearts, as well as the utilization of cell-free DNA for evaluating graft rejection, are laying the groundwork for further advancements in non-invasive rejection diagnosis and the expansion of the donor pool.

Keywords: advanced heart failure; heart transplant; immunosuppressive therapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 2
Figure 2
TransMedics Organ Care System. Heart (panel A) and the Paragonix SherpaPak Cardiac Transport System (panel B). The Organ Care System circulates heated, oxygenated perfusate through the cardiac preservation module circuit. Blood, supplemented with TransMedics solutions, is pumped to the aorta and coronary arteries through an oxygenator and warmer. Deoxygenated blood returns to the right ventricle and is expelled through the pulmonary artery to the reservoir for recirculation (Panel A). Cross-section of the assembled Paragonix SherpaPak cardiac transport system, showing a heart preserved within the system. This system uses controlled hypothermic preservation (achieved through stable temperatures between 4 °C and 8 °C) to maintain the viability of the donor heart by minimizing damage to the myocardium during transport (Panel B). Modified from ref. [58].
Figure 1
Figure 1
Scanning electron micrograph of Tolypocladium inflatum an ascomycete fungus that produces the immunosuppressant agent cyclosporine.
See this image and copyright information in PMC

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