Heart transplantation in Berlin.

Since July 1983, our group experience with heart transplantation as a routine procedure now includes 346 patients. Predominant diagnosis was dilated cardiomyopathy (64%). The age range was 3 months to 68 years (mean 44.3 years). Immunosuppression has followed several evolving protocols and now emphasizes preoperative administration of cyclosporine A and quadruple immunosuppression with additional azathioprine, cortisone medication, and early postoperative cytolytic prophylaxis with rabbit ATG. We have accepted donor organs up to 55 years without coronary angiography and with very satisfying functional and late results. The diagnosis of rejection by endomyocardial biopsy has been supplemented by routine use of telemetric intramyocardial electrogram monitoring and M-mode echocardiography. Routine use of these methods has distinctly increased diagnostic safety. Eleven children between the ages of 3 months and 18 years have been transplanted with a 72% overall survival rate. Four children younger than age 8 have been followed with noninvasive methods for rejection diagnosis exclusively. A bridge to transplantation program was initiated in July 1987; 31 patients were bridged, 18 of whom could be transplanted. Thirteen patients were discharged after a mean posttransplant period of 31 days. Future development issues will include extension of donor heart criteria, noninvasive diagnosis of rejection, and increasing experience with mechanical bridging.