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STATE-OF-THE-ART PAPER

The Changing Face of Heart Transplantation

Division of Cardiovascular Medicine, Stanford University, Palo Alto, California.

Manuscript received February 26, 2008; revised manuscript received May 14, 2008, accepted May 20, 2008.

^_* Reprint requests and correspondence: Dr. Sharon A. Hunt, Division of Cardiovascular Medicine, Stanford University, 300 Pasteur Drive, Falk CVRB, Stanford Medical Center, Palo Alto, California 94305. (Email: shunt{at}cvmed.stanford.edu).

It has been 40 years since the first human-to-human heart transplant performed in South Africa by Christiaan Barnard in December 1967. This achievement did not come as a surprise to the medical community but was the result of many years of early pioneering experimental work by Alexis Carrel, Frank Mann, Norman Shumway, and Richard Lower. Since then, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have significantly improved survival. In this article, we hope to give a perspective on the changing face of heart transplantation. Topics that will be covered in this review include the changing patient population as well as recent advances in transplantation immunology, organ preservation, allograft vasculopathy, and immune tolerance.

Key Words: heart transplantation • heart failure • immunology • cardiac surgery • coronary artery disease

Abbreviations and Acronyms   AMR = antibody-mediated rejection   CHD = congenital heart disease   CNI = calcineurin inhibitor   GEP = gene expression profiling   HLA = human leukocyte antigen   ISHLT = International Society for Heart and Lung Transplantation   MCS = mechanical cardiac support   RF = renal failure

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