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Herztransplantation 2012

Ein Update

  • Published:
CardioVasc Aims and scope

Abstract

Die orthotope Herztransplantation (HTX) hat sich in den letzten Jahrzehnten zu einer festen Größe in der Behandlung der terminalen Herzinsuffizienz entwickelt. Das Überleben in der Akutphase nach HTX liegt bei ca. 90%. Die Langzeitprognose mit einem Überleben von über 50% nach 11 Jahren geht einher mit der immer effizienteren und patientenadaptierten Immunsuppression und der intensiven Betreuung der Patienten in Spezialambulanzen. Aufgrund der Organknappheit hat sich die Wartezeit für hochdringliche Patienten blutgruppenabhängig verlängert und beträgt zurzeit für häufige Blutgruppen (z. B. Blutgruppe A und 0) bis zu 6 Monate. Dieses führt dazu, dass neben den medikamentösen Therapien mit Betablockern, ACE-Hemmern und Diuretika, die häufig zu einer anfänglichen Stabilisierung der Patienten beitragen, die Kunstherzsysteme als Alternative zur HTX in zunehmender Anzahl implantiert werden. Diese sind jedoch nach wie vor aufgrund zahlreicher Limitationen und dem im Vergleich zur HTX schlechteren Langzeitüberleben noch keine gleichwertige Alternative. Experimentelle Therapien, wie die Übertragung von artfremden Herzen (Xenotransplantation) oder in Bioreaktoren gezüchtetes Herzmuskelgewebe (Tissue Engineering), haben noch nicht den Sprung in die klinische Anwendung geschafft.

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Literatur

  1. Carrel A, Guthrie CC: The transplantation of veins and organs. Am Med 1905; 10:1101.

    Google Scholar 

  2. Carrel A: The surgery of blood vessels. Johns Hopkins Hosp Bull 1907; 18:18.

    Google Scholar 

  3. Langer RM. Vladimir P. Demikhov, a pioneer of organ transplantation. Transplant Proc. 2011; 43(4):1221–2.

    Google Scholar 

  4. Barnard CN: A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Capetown. S Afr Med J 1967; 41:1271.

    PubMed  CAS  Google Scholar 

  5. Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dobbels F, Kirk R, Rahmel AO, Stehlik J, Hertz MI. The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Lung and Heart-Lung Transplant Report 2011. J Heart Lung Transplant. 2011; 30(10):1104–22.

    Article  PubMed  Google Scholar 

  6. Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, Pagani FD, Piña IL, Semigran MJ, Walsh MN, Wiener DH, Yancy CW Jr; ACCF/AHA/ACP Task Force. ACCF/AHA/ACP/HFSA/ISHLT 2010 clinical competence statement on management of patients with advanced heart failure and cardiac transplant: a report of the ACCF/AHA/ACP Task Force on Clinical Competence and Training. J Am Coll Cardiol. 2010 Jul 27; 56(5):424–53

    Article  PubMed  Google Scholar 

  7. Murali S, Kormos RL, Uretsky BF, Schechter D, Reddy PS, Denys BG, Armitage JM, Hardesty RL, Griffith BP. Preoperative pulmonary hemodynamics and early mortality after orthotopic cardiac transplantation: the Pittsburgh experience. Am Heart J. 1993; 126(4):896–904.

    Article  PubMed  CAS  Google Scholar 

  8. von Scheidt W, Costard-Jaeckle A, Stempfle HU, Deng MC, Schwaab B, Haaff B, Naegele H, Mohacsi P, Trautnitz M; PROPHET Study Group. Prostaglandin E1 testing in heart failure-associated pulmonary hypertension enables transplantation: the PROPHET study. J Heart Lung Transplant. 2006; 25(9):1070–6.

    Article  Google Scholar 

  9. Spaderna H, Weidner G, Koch KC, Kaczmarek I, Wagner FM, Smits JM; Waiting for a New Heart Study Group. Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study. J Heart Lung Transplant. 2012; 31(1):16–26.

    Article  PubMed  Google Scholar 

  10. Lower RR, Shumway N. Studies on orthotopic homotransplantation of the canine heart. Surg Forum 1960, 11: 18–19

    PubMed  CAS  Google Scholar 

  11. Dreyfus G, Jebara V, Mihaileanu S, et al: Total orthotopic heart transplantation: an alternative to the standard technique. Ann Thorac Surg 1991; 52:1181.

    Article  PubMed  CAS  Google Scholar 

  12. Laske A, Carrel T, Niederhäuser U, Pasic M, von Segesser LK, Jenni R, Turina MI. Modified operation technique for orthotopic heart transplantation. Eur J Cardiothorac Surg. 1995; 9(3):120–6.

    Article  PubMed  CAS  Google Scholar 

  13. Shah M, Anderson AS, Jayakar D, Jeevanandam V, Feldman T. Balloon-expandable stent placement for superior vena cava-right atrial stenosis after heart transplantation. J Heart Lung Transplant. 2000; 19(7):705–9.

    Article  PubMed  CAS  Google Scholar 

  14. Sze DY, Robbins RC, Semba CP, Razavi MK, Dake MD. Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses. J Thorac Cardiovasc Surg. 1998; 116(2):253–61.

    Article  PubMed  CAS  Google Scholar 

  15. Gummert JF, Funkat AK, Beckmann A, Ernst M, Hekmat K, Beyersdorf F, Schiller W.Cardiac surgery in Germany during 2010: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery Thorac Cardiovasc Surg. 2011; 59(5):259–67.

    Article  PubMed  CAS  Google Scholar 

  16. Heim C, Abele-Ohl S, Eckl S, Ramsperger-Gleixner M, Mahmoudian S, Weyand M, Stamminger T, Ensminger SM. Murine cytomegalovirus infection leads to increased levels of transplant arteriosclerosis in a murine aortic allograft model. Transplantation. 2010 27; 90(4):373–9.

    Article  Google Scholar 

  17. Ikonen TS, Gummert JF, Serkova N, Hayase M, Honda Y, Kobayase Y, Hausen B, Yock PG, Christians U, Morris RE. Efficacies of sirolimus (rapamycin) and cyclosporine in allograft vascular disease in non-human primates: trough levels of sirolimus correlate with inhibition of progression of arterial intimal thickening. Transpl Int. 2000; 13 Suppl 1:S314–20.

    Article  PubMed  Google Scholar 

  18. Ikonen TS, Gummert JF, Hayase M, Honda Y, Hausen B, Christians U, Berry GJ, Yock PG, Morris RE. Sirolimus (rapamycin) halts and reverses progression of allograft vascular disease in non-human primates. Transplantation. 2000 Sep 27;70(6):969–75.

    Article  PubMed  CAS  Google Scholar 

  19. Gummert JF, Barten MJ, van Gelder T, Billingham ME, Morris RE. Pharmacodynamics of mycophenolic acid in heart allograft recipients: correlation of lymphocyte proliferation and activation with pharmacokinetics and graft histology. Transplantation. 2000 15;70(7):1038–49.

    Article  PubMed  CAS  Google Scholar 

  20. Bae JH, Rihal CS, Edwards BS, Kushwaha SS, Mathew V, Prasad A, Holmes DR Jr, Lerman A. Association of angiotensin-converting enzyme inhibitors and serum lipids with plaque regression in cardiac allograft vasculopathy. Transplantation. 2006 27;82(8):1108–11.

    Article  PubMed  CAS  Google Scholar 

  21. Mehra MR, Crespo-Leiro MG, Dipchand A, Ensminger SM, Hiemann NE, Kobashigawa JA, Madsen J, Parameshwar J, Starling RC, Uber PA. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy 2010. J Heart Lung Transplant. 2010;29:717–727.

    Article  PubMed  Google Scholar 

  22. Subramanian V, Ramachandran S, Klein C, Wellen JR, Shenoy S, Chapman WC, Mohanakumar T. ABO-incompatible organ transplantation. Int J Immunogenet. 2012 Feb 18

  23. Emin A, Rogers CA, Thekkudan J, Bonser RS, Banner NR; Steering Group, UK Cardiothoracic Transplant Audit Antithymocyte globulin induction therapy for adult heart transplantation: a UK national study. J Heart Lung Transplant. 2011; 30(7):770–7.

    Article  PubMed  Google Scholar 

  24. Taylor DO, Barr ML, Radovancevic B, Renlund DG, Mentzer RM Jr, Smart FW, Tolman DE, Frazier OH, Young JB, VanVeldhuisen P. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 1999; 18:336.

    Article  PubMed  CAS  Google Scholar 

  25. Meiser BM, Uberfuhr P, Fuchs A, Schmidt D, Pfeiffer M, Paulus D, Schulze C, Wildhirt S, Scheidt WV, Angermann C, Klauss V, Martin S, Reichenspurner H, Kreuzer E, Reichart B. Single center randomized trial comparing tacrolimus (FK 506) and cyclosporine in the prevention of acute myocardial rejection. J Heart Lung Transplant 1998; 17:782.

    PubMed  CAS  Google Scholar 

  26. Kobashigawa J, Miller L, Renlund D, Mentzer R, Alderman E, Bourge R, Costanzo M, Eisen H, Dureau G, Ratkovec R, Hummel M, Ipe D, Johnson J, Keogh A, Mamelok R, Mancini D, Smart F, Valantine H. A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients. Mycophenolate Mofetil Investigators. Transplantation. 1998 27;66(4):507–15.

    Article  PubMed  CAS  Google Scholar 

  27. Mancini D, Pinney S, Burkhoff D, LaManca J, Itescu S, Burke E, Edwards N, Oz M, Marks AR. Use of rapamycin slows progression of cardiac transplantation vasculopathy. Circulation 2003; 108: 48–53.

    Article  PubMed  CAS  Google Scholar 

  28. Topilsky Y, Hasin T, Raichlin E, Boilson BA, Schirger JA, Pereira NL, Edwards BS, Clavell AL, Rodeheffer RJ, Frantz RP, Maltais S, Park SJ, Daly RC, Lerman A, Kushwaha SS. Sirolimus as primary immunosuppression attenuates allograft vasculopathy with improved late survival and decreased cardiac events after cardiac transplantation. Circulation. 2012; 125(5):708–20.

    Article  PubMed  CAS  Google Scholar 

  29. Kushwaha SS, Khalpey Z, Frantz RP, Rodeheffer RJ, Clavell AL, Daly RC, McGregor CG, Edwards BS. Sirolimus in cardiac transplantation: use as a primary immunosuppressant in calcineurin inhibitor-induced nephrotoxicity. J Heart Lung Transplant. 2005;24:2129–2136.

    Article  PubMed  Google Scholar 

  30. Keogh A, Macdonald P, Kaan A, Aboyoun C, Spratt P, Mundy J. Efficacy and safety of pravastatin vs simvastatin after cardiac transplantation. J Heart Lung Transplant. 2000;19(6):529–37.

    Article  PubMed  CAS  Google Scholar 

  31. Eckl S, Heim C, Abele-Ohl S, Hoffmann J, Ramsperger-Gleixner M, Weyand M, Ensminger SM. Combination of clopidogrel and everolimus dramatically reduced the development of transplant arteriosclerosis in murine aortic allografts. Transpl Int. 2010; 23(9):959–66.

    PubMed  CAS  Google Scholar 

  32. Stewart S, Winters GL, Fishbein MC, Tazelaar HD, Kobashigawa J, Abrams J, Andersen CB, Angelini A, Berry GJ, Burke MM, Demetris AJ, Hammond E, Itescu S, Marboe CC, McManus B, Reed EF, Reinsmoen NL, Rodriguez ER, Rose AG, Rose M, Suciu-Focia N, Zeevi A, Billingham ME. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005; 24(11):1710–20.

    Article  PubMed  Google Scholar 

  33. Doering LV, Hickey K, Pickham D, Chen B, Drew BJ. Remote noninvasive allograft rejection monitoring for heart transplant recipients: study protocol for the novel evaluation with home electrocardiogram and remote transmission (NEW HEART) study. BMC Cardiovasc Disord. 2012 2;12:14.

    Article  Google Scholar 

  34. From AM, Maleszewski JJ, Rihal CS. Current status of endomyocardial biopsy. Mayo Clin Proc. 2011; 86(11):1095–102.

    Article  PubMed  Google Scholar 

  35. Garlicki M, Wierzbicki K, Przybyłowski P, Drop D, Biernat M, Rudziski P, Olszewska B, Dziatkowiak A. The incidence of malignancy in heart transplant recipients. Ann Transplant 1998;3(4):41–7.

    PubMed  CAS  Google Scholar 

  36. Linares L, Sanclemente G, Cervera C, Hoyo I, Cofán F, Ricart MJ, Pérez-Villa F, Navasa M, Marcos MA, Antón A, Pumarola T, Moreno A. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc. 2011 Jul-Aug;43(6):2145–8.

    Article  PubMed  CAS  Google Scholar 

  37. Baron C, Forconi C, Lebranchu Y. Revisiting the effects of CMV on long-term transplant outcome. Curr Opin Organ Transplant. 2010; 15(4):492–8.

    Article  PubMed  Google Scholar 

  38. Schepis T, Achenbach S, Weyand M, Raum P, Marwan M, Pflederer T, Daniel WG, Tandler R, Kondruweit M, Ropers D. Comparison of dual source computed tomography versus intravascular ultrasound for evaluation of coronary arteries at least one year after cardiac transplantation. Am J Cardiol. 2009 15; 104(10):1351–6.

    Article  PubMed  Google Scholar 

  39. Tona F, Osto E, Tarantini G, Gambino A, Cavallin F, Feltrin G, Montisci R, Caforio AL, Gerosa G, Iliceto S. Coronary flow reserve by transthoracic echocardiography predicts epicardial intimal thickening in cardiac allograft vasculopathy. Am J Transplant. 2010; 10(7):1668–76.

    Article  PubMed  CAS  Google Scholar 

  40. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, Ulisney KL, Baldwin JT, Young JB. Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant. 2011; 30(2):115–23.

    Article  PubMed  Google Scholar 

  41. Drews T, Dandel M, Krabatsch T, Potapov E, Stepanenko A, Hennig E, Lehmkuhl HB, Pasic M, Weng Y, Hetzer R. Long-term mechanical circulatory support in 198 patients: largest single-center experience worldwide. ASAIO J. 2011; 57(1):9–16

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Deutschland

    Thomas Pühler, Stephan Ensminger, Michael Benzinger, Andre Renner, Jochen Börgermann, Kavous Hakim, Michael Schoenbrodt, Michiel Morshuis, Uwe Schulz & Jan Gummert

  2. Klinik für Kardiologie, Herz-und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland

    Olaf Oldenburg

Authors
  1. Thomas Pühler
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  2. Stephan Ensminger
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  3. Michael Benzinger
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  4. Andre Renner
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  5. Jochen Börgermann
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  7. Michael Schoenbrodt
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  11. Jan Gummert
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Correspondence to Thomas Pühler.

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Pühler, T., Ensminger, S., Benzinger, M. et al. Herztransplantation 2012. CV 12, 50–55 (2012). https://doi.org/10.1007/s15027-012-0216-y

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