Cardiac transplantation. Emerging from an experiment to a service.

Cardiac transplantation was resumed at the University Health Center of Pittsburgh in 1980 after a hiatus of 12 years. Prior to April 15, 1986, 270 hearts had been transplanted. Participants have been forced to reorder personal, professional, and institutional commitments to adapt to new demands of pre- and post-operative care and to develop flexibility in the operative scheduling of routine cardiac surgical cases. The actuarial survival has been 78, 69, and 64% at 1, 2, and 3 years. Much has been learned about evolving immunosuppression based on cyclosporine and of the allogenic response. An increasing proportion of recipients are mortally ill (54%), and for these urgent patients the wait for a donor organ continues to lengthen. The cardiac surgeon performing transplantations will need to grow with allied developments in xenotransplantation and mechanical cardiac support devices in order to keep pace with his evolving specialty.