Heart transplantation--Stanford experience.

Heart transplantation has evolved from an experimental procedure with minimally acceptable results to a therapeutic option for patients with end-stage heart disease. Since 1968, 429 patients have undergone cardiac transplantation at Stanford. The recipient diagnosis was cardiomyopathy in 205 patients, coronary artery disease in 188, and valvular heart disease in 20 patients. The age range was 5 months to 60 years with equal survival among children and adults. Immunosuppression included a 3-drug protocol of CsA, azathioprine, and prednisone. The current one- and 5-year survival is 83% and 55%, respectively. A totally implantable electrically driven left ventricular assist device (Novacor) has been implanted in 6 patients as a "bridge-to-transplantation." Four patients received cardiac transplants after a mean support period of 7 days (range 2.0-16.5 days). Of the four transplanted patients, 3 (75%) are alive at 32, 11, and 4 months. With improved immunosuppression and standardized protocols, heart transplantation has been successfully employed by many centers. The number of heart transplants has risen from 103 in 1982 to 719 in 1985. Undoubtedly, due to the expanding number of centers, future issues will include distribution of donors and minimal acceptable standards for heart transplantation centers.