Cytokine Profile in Heart Transplantation

Abstract

The founder of modern organ transplantation is Alexis Carrel (1873–1944) because of his extensive work on vascular anastomosis and accomplishment of the first successful heart transplantation (HT) in a canine model using carotid artery and jugular vein anastomosis in 1905 [1]. The realization of the first human-to-human HT was closely related to the work of Norman Shumway and Richard Lower at Stanford University, who described the technique for orthotopic canine HT [2, 3]. Shumway and colleagues not only worked extensively on an efficient surgical technique for HT, but also performance characteristics of the allograft and control of allograft rejection [2, 4–10]. However, Christiaan N. Barnard (1922–2001) performed the world’s first successful human-to-human HT in Groote Schuur Hospital, Cape Town, in 1967 [11]. The immunosuppressive regimen of Barnard and colleagues in their first three patients included corticosteroids, azathioprine, local irradiation to the transplanted heart, and antilymphocyte globulin [12, 13]. Dr. Barnard [12] pointed out that “one day this problem will be solved, we will be able to induce tolerance in our patients and organ transplantation will be a curative and not a palliative procedure.” Between 1968 and1970, a total of 166 (102, 48, and 16 annually) HTs were performed worldwide with unacceptably high mortality rates due to either rejection or infection [14]. These unfavorable outcomes led to the investigation of new immunosuppressive regimens, and most centers have stopped practicing HT. Another milestone in immunosuppression was reached in 1972 when cyclosporine was discovered in Basel, Switzerland, and subsequently approved for clinical use in 1983 [15–19]. During that period, only Shumway and his team continued using HT at Stanford University and performed 227 HT procedures between 1968 and 1981 [20]. Today, HT provides the gold standard treatment modality for patients with end-stage heart failure [21]. Since 1967, over 100,000 HTs have been performed worldwide. In the last decade, between 3,600 and 3,850 HTs have been performed in 388 countries registered with International Society of Heart and Lung transplantation (ISHLT) Registry [21, 22].