Heart transplant

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Principle of heart transplant. The donor heart is connected to the vena cava, pulmonary artery, and aorta

A heart transplant (abbreviated HTX ; English heart transplantation ) is the transplantation of a heart from an organ donor to a receiver.

definition

In general, heart transplantation refers to the transplantation of organs between people.

The still biologically active heart of an organ donor is implanted in a recipient. The determination of brain death is made by a medical committee, which makes this diagnosis independently of the transplant medical team. The recipient's heart can either be removed (orthotopic procedure) or left in the body to support the donor's heart (heterotopic procedure).

Immunosuppression

Since a rejection reaction has to be suppressed in any case, immunosuppression is necessary for life. For this, the observation of the immune reaction is of crucial importance, for example echocardiography (ultrasound of the heart) is used as a decisive assessment method. Recent research shows that in a blood sample, the amount of free DNA ( DNA outside cells) from the donor organ increases before echocardiography can reveal anything. In the long-term, a combination of steroids , azathioprine and cyclosporine A is usually used as an immunosuppressive therapy , possibly additionally initially with lytic antibodies against T lymphocytes.

Risks

Heart transplantation is a profound and risky procedure, the benefits of which must be carefully weighed. In a Germany-wide study it was found that the transplant was only statistically beneficial for high-risk patients.

The necessary immunosuppressive therapy carries the risk of inflammation because the immune system is severely impaired.

Contraindications

Some patients are unsuitable for a heart transplant, especially if they have other (non-cardiac) circulatory problems. The following circumstances can increase the complication rate during surgery:

  • Kidney, lung or liver disease
  • insulin dependent diabetes with other organ dysfunction
  • other life threatening diseases
  • Vascular diseases of the neck and leg arteries
  • increased pulmonary vascular resistance
  • young thromboembolism
  • Age over 60 years (different information depending on the center)
  • Alcohol or drug abuse

Survival rate

The 5-year survival rate is 70–80%.

history

The first experimental heart transplant took place in Vienna in 1905 on a dog. In 1964, James D. Hardy transplanted the heart of a chimpanzee into a comatose patient, where it beat for about an hour. The world's first successful curative human heart transplant was carried out on December 3, 1967 by Christiaan Barnard in the Groote Schuur Hospital in Cape Town . The vascular surgery execution of the heart transplant corresponded to the technique described by Ernst Jeger (1884-1915), a student of Alexis Carrel , 1913 in The Surgery of the Blood Vessels and the Heart . To what extent the assistant was involved in transplants in the animal experiment, Hamilton Naki , before Barnard's operation , is controversial. In the past there have been some press releases ascribing a crucial role to Naki, which was hushed up during apartheid because of his skin color. However, many of these communications had to be revised. However, the patient Louis Washkansky succumbed to pneumonia 18 days after the operation . The intervention triggered an immense worldwide media response, with some very controversial debates. Washkansky was mentioned almost constantly by his full name - also with nicknames like "Washy" - and shown in earlier and current pictures. In 1972, the media hype prompted Eckart Roloff to speak of the “journalistic discovery of the patient” in his dissertation on press coverage of heart transplants.

Just three days after Barnard's first heart transplant, Adrian Kantrowitz transplanted a child's heart at Maimonides Medical Center in Brooklyn , New York City . The operation failed, however; the child died shortly after the operation. In early 1968, Norman Shumway transplanted the second heart in the United States at Stanford University . Christian Cabrol transplanted the first heart in Europe on April 27, 1968 at the Hôpital de la Salpêtrière . However, the patient Clovis Roblain died just 3 days after the operation.

Other known people with the first heart transplants were:

  • Philip Blaiberg of the Republic of South Africa was operated on by Barnard on January 2, 1968, the second adult patient in the world, and died in August 1969
  • Robert McKee from the USA in August 1968, died in May 1970
  • Louis Russel from the USA received two grafts, the last one on August 24, 1968
  • Edward Falk from the USA with the first simultaneous transplant of the heart and two lungs on September 15, 1968 by Denton Cooley . Falk died six days after the operation.
  • Leo Allan Boyd from Canada in November 1968, died in March 1970

From December 1967 to early September 1970 a total of 164 hearts were transplanted. At this point there were still 20 survivors. The second heart transplant in France, carried out in Marseille in November 1968 , was for a long time the most successful: Emmanuel Vitria then lived with a donor heart for 19 years and died in 1987 at the age of 67.

In 1974 Barnard carried out a heterotopic heart transplant (Heterotope HTx) with the patient Ivan Taylor for the first time , in which the weakened heart remains in the body and a transplanted heart rests on the existing one for relief.

In the Federal Republic of Germany , the first heart transplant was carried out on a 36-year-old patient on February 13, 1969 by the surgeon Rudolf Zenker in the Surgical University Clinic in Munich. The patient died 27 hours after the transplant. The first heart transplant after 1969 was only resumed after the development of the new drug with the drug ciclosporine on May 7, 1981 at the German Heart Center in Munich and was successful. In 1984 there were four heart transplant centers in the Federal Republic of Germany: Klinikum München-Großhadern (LMU), German Heart Center Munich (TU), Hannover Medical School and the Hamburg-Eppendorf University Medical Center .

The first heart transplant in Switzerland took place on April 14, 1969 by the surgeon Åke Senning at the Zurich Cantonal Hospital . Further heart transplants subsequently took place in Lausanne and Geneva, and later in Bern and Basel. In 1985, the transplants in Zurich were resumed by Marko Turina . There are currently transplant centers in Lausanne / Geneva, Bern and Zurich in Switzerland.

The first heart transplant in Austria was carried out on October 12, 1983 at the University Hospital Innsbruck by a team led by Raimund Margreiter and Franz Gschnitzer on Josef Wimmer , a patient with ischemic cardiopathy . Wimmer recovered well after the operation, but died in 1986 after a second heart transplant. The first heart transplant in Vienna was carried out on March 3, 1984 by Ernst Wolner and Axel Laczkovics . Your patient died of pneumonia a week later. The first heart transplant in Graz on March 12, 1984 was headed by Julius Kraft-Kinz and Bruno Rigler , and the patient survived the procedure by eight weeks. The next patient in Vienna - a 45-year-old man with dilative cardiomyopathy - was transplanted on October 23, 1984 and lived for three months after that. According to Ernst Wolner, a major shortcoming of the intensive care unit at the Vienna General Hospital was the lack of a sterile room, which was removed during the new building .

The first hearts were transplanted in Berlin in 1986/87: by Roland Hetzer in West Berlin and by Helmut Wolff at the Charité in East Berlin . In the German Democratic Republic , the first 37 others followed until the fall of the Berlin Wall .

In 2004, a total of 398 hearts were transplanted in 24 clinics in Germany. A heart transplant in Germany costs around 170,000 euros (as of 2012).

The discovery of cyclosporine A - from the Norwegian sac fungi Tolypocladium inflatum ( Gams ) and Cylindrocarpon lucidum (Booth), which was first used in 1978 by Roy Calne at Cambridge University as an immunosuppressant as part of a transplant, effectively reduced defense reactions and the number the number of heart transplants has increased steadily since 1981. Norman Shumway at Stanford University achieved the first long-term results with him.

At the Munich-Großhadern Clinic, preclinical trials for xenogenic heart transplants are currently underway (as of 2014) , with monkeys receiving pig hearts.)

Number of heart transplants

year Worldwide
1967 2
1968 100
1969 53 (including 1 in Germany)
1970 30th
1971 25th
1972 30th
1973 45
1974 40
1975 42
1976 42
1977 50
1978 83
1979 70
1980 100
1981 90 (including 6 in Germany)
1982 189 (including 10 in Germany)
1983 318 (including 25 in Germany)
1984 665 (including 65 in Germany)
1985 1,182 (thereof 73 in Germany)
1986 2,159 (of which at least 1 in the GDR)
1987 2,713
1988 3.136
1989 3,363
1990 4,003 (including approx. 450 in Germany)
1991 4.171
1992 4,203
1993 4,364
1994 4,429
1995 4,396
1996 4.263
1997 4,199
1998 3,864
1999 3,581
2000 3,433
2001 3,390
2002 3,283
2003 3,226 (of which 394 in Germany and 62 in Austria)
2004 3,065 (of which 398 in Germany and 63 in Austria)
2005 3,185 (of which 394 in Germany and 55 in Austria)
2006 3,205 (including 412 in Germany and 54 in Austria)
2007 2,345 (394 in Germany and 57 in Austria)
Jan. 2008 - June 2009 3,284 (382 in Germany and 62 in Austria)
Jan. 2009 - June 2010 3,608

From 1967 to 2000, according to the International Society for Heart and Lung Transplantation , based in Addison (Texas), 55,359 heart transplants were performed in 301 officially known centers around the world by the end of 1999. From 1967 to June 30, 2007 the number rose to a total of 80,106 heart transplants worldwide.

Heart transplant in children

For some congenital heart defects, heart transplantation is sometimes the only long-term therapeutic option in severe cases. In 1985, the first successful heart transplants in toddlers and infants took place in the USA. These operations have also been available in German clinics since 1988. The overwhelming majority of the operated children can lead a largely normal life and are physically resilient. Since the transplanted heart remains a latently rejected foreign body, it is threatened by various diseases and may have to be retransplanted later.

In most cases, the so-called hypoplastic left heart syndrome is the reason for the operation, and the so-called dilated cardiomyopathy is the second most common underlying disease.

The average waiting time for a heart transplant in smaller children in Germany is around 180 to 200 days (2006); alternatively, this can be bridged with a mechanical heart support system until the transplant. In 2006, eight heart transplants were performed on children in Germany. All affected children had the urgency level HU (High Urgency).

The mortality rate averages five percent within the first four weeks after a heart transplant.

Heart transplant centers in Germany

Heart transplant centers in Austria

media

  • Hidden Heart (The Heart of the Other) , German-Swiss documentary film from 2008 about the first heart transplant in 1967, length: 97 min.
  • Hidden Heart in the Internet Movie Database (English)
  • Live recordings of a heart transplant operation in September 2007 at the Montefiore Einstein Heart Center in New York: or-live.com (English)

Studies

  • Transplant results : In a collective study (Collaborative Transplant Study) the results from 400 transplant centers in 45 countries on the transplantation of kidneys, heart, lungs, liver and pancreas are summarized and constantly updated.
  • Wolfgang Albert researched the psychosomatics of the heart . Among other things, he examined 126 heart transplant patients over the long term. He reported on his research results in an interview published in GEO magazine in 2019 . See: Psychosomatics of the Heart

literature

  • Eckart Klaus Roloff : The coverage of heart transplants in the West German press. A testimony-analytical case study on the phenomena of medical journalism. Phil. Diss. Salzburg 1972.
  • Oliva Wiebel-Fanderl: Heart transplantation as a narrated experience: people between cultural traditions and medical-technical progress. LIT-Verlag 2003, ISBN 978-3-8258-6865-9 .
  • Friedhelm Beyersdorf and Jürgen Martin: Advances in Heart Transplantation. UNI-MED-Verlag 2005, ISBN 978-3-89599-829-4
  • Christof Schmid, Jan D. Schmitto, Hans-Heinrich Scheld: Guide to Heart Transplantation. Steinkopff-Verlag, 3rd edition 2009, ISBN 978-3-7985-1872-8 .
  • Eckart Roloff : The journalistic discovery of the patient. A press analysis on medical journalism and the first heart transplants. Nomos 2013, ISBN 978-3-8487-0731-7 (Slightly edited version of the Salzburg dissertation from 1972 with a detailed foreword and afterword from 2013).
  • Guide to Heart Transplantation in Children. Federal Association for Children with Heart Disease e. V.
  • Manfred G. Krukemeyer, Arno E. Lison: Transplant Medicine - A Guide for the Practitioner . Walter de Gruyter, 2006, ISBN 3-11-018927-5

Web links

Wiktionary: Heart transplantation  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ Marieke Degen : Donor organs - blood test detects rejection reactions at an early stage , Deutschlandfunk " Forschung aktuell " from June 19, 2014
  2. ↑ Transplant Study (PDF; 288 kB; English)
  3. ↑ Stefan Endres: Specialist examination in internal medicine: In cases, questions and answers . Elsevier, 2008, ISBN 3-437-23332-7 , pp. 379 .
  4. ↑ Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 161.
  5. ↑ a b Deutsches Ärzteblatt (2008)
  6. ↑ Stefan von Smmoggy: Hidden Heart: As a friend and colleague . In: Deutsches Ärzteblatt , 2008.
  7. ^ Corrections: Hamilton Naki . In: BMJ , September 1, 2005, doi: 10.1136 / bmj.331.7515.519-f
  8. ^ Margalit Fox: Editors Note . In: New York Times , August 27, 2005.
    Note: The Editors Note is at the very end of the article
  9. ^ Department of Error . In: The Lancet , August 13, 2005, doi: 10.1016 / S0140-6736 (05) 67097-3
  10. ↑ A similar media hype was repeated in 1983 after the first heart transplant in Austria on patient Josef Wimmer .
  11. ^ Eckart Klaus Roloff: The coverage of heart transplants in the West German press. A testimony-analytical case study on the phenomena of medical journalism. Phil. Dissertation, Salzburg 1972. 356 pages.
    Furthermore: Eckart Roloff: The journalistic discovery of the patient. A press analysis on medical journalism and the first heart transplants. Nomos, Baden-Baden 2013, ISBN 978-3-8487-0731-7 (Slightly edited version of the dissertation with a detailed foreword and afterword from 2013)
  12. ↑ Dr. Adrian Kantrowitz, Cardiac Pioneer, Dies at 90 . New York Times , Nov. 19, 2008; accessed on December 5, 2011
  13. ^ Mort du professeur Christian Cabrol, qui avait réalisé la première greffe cardiaque en Europe in 1968. In: Le Monde . Groupe La Vie-Le Monde, June 16, 2017, accessed June 16, 2017 (French).
  14. ↑ National hero . In: The time . No. 19 , 1968 ( zeit.de ).
  15. ↑ "Think of your heart, Bicou" . In: Der Spiegel . No. 49 , 1978 ( online ).
  16. ↑ a b First heart transplant in Austria: A second heart beats next to your own in your chest . In: Arbeiter-Zeitung . Vienna October 13, 1983, p. 5 ( Arbeiter-zeitung.at - the open online archive - digitized).
  17. ↑ Died: Emmanuel Vitria . In: Der Spiegel . No. 21 , 1987 ( online ).
  18. ^ First heart transplant in Switzerland . srf.ch; accessed on April 5, 2018.
  19. ↑ Heart transplant. University Hospital Zurich, accessed on April 5, 2018 .
  20. ↑ Raimund Margreiter , Transplantation in Austria - a historical review . In: Austrian Transplant Journal , issue 1/2017 ( online )
  21. ↑ a b H. Wolff: On the development of surgery and surgical research in the GDR . German Society for Surgery - Announcements 1/2012, pp. 1–8
  22. ↑ What health costs . In: fit! , No. 4, 2013, p. 24; dak.de ( Memento from December 12, 2013 in the Internet Archive ; PDF).
  23. ↑ Paolo Brenner, Hermann Reichenspurner, Michael Schmoeckel, Cosmas Wimmer, Alexander Rucker, Veronika Eder, Bruno Meiser , Michael Hinz, Thomas Felbinger, Josef Muller-Hocker, Claus Hammer, Bruno Reichart: IG-therasorb immunoapheresis in orthotopic xenotransplantation of baboons with landrace pigs hearts ( Memento from December 5, 2014 in the Internet Archive ) (PDF)
  24. ↑ B Reichart, S Guethoff, T Mayr, M Thormann, S Buchholz, J Postrach, D Ayares, RB Elliott, P Tan, A Kind, C Hagl, P Brenner , JM. Abicht: Discordant cardiac xenotransplantation: broadening the horizons . In: Eur J Cardiothorac Surg. , 2014 Jan, 45 (1), pp. 1–5, doi: 10.1093 / ejcts / ezt483 , Epub 2013 Oct 3.
  25. ↑ A Bauer, J Postrach, M Thormann, S Blanck, C Faber, B Wintersperger, S Michel, JM Abicht, F Christian, C. Schmitz, M Schmoeckel, B Reichart, P Brenner : First experience with heterosexual topic thoracic pig-to-baboon cardiac xenotransplant . In: Xenotransplantation , 2010 May-Jun, 17 (3), pp. 243-249. doi: 10.1111 / j.1399-3089.2010.00587.x .
  26. Jump up ↑ P Brenner, M Schmoeckel, C Wimmer, V Eder, A Rucker, T Felbinger, S Uchita, M Hinz, U Brandl, B Meiser, H Reichenspurner, C Hammer, B. Reichart: Mean xenograft survival of 14.6 days in a small group of hDAF-transgenic pig hearts transplanted orthotopically into baboons . In: Transplant Proc. , 2005 Jan-Feb, 37 (1), pp. 472-476.
  27. ^ DSO: Transplant Centers. German Organ Transplantation Foundation, accessed on October 1, 2013 .
  28. ↑ Transplant Centers. Eurotransplant, accessed March 27, 2019 .
  29. ↑ LKH Graz stops heart transplants for the time being. steiermark.orf.at, accessed on March 27, 2019 .