Five years of heart transplantation in Pittsburgh.

Looking over the five years of HTx experience in Pittsburgh we conclude that a reasonable success has been achieved and that the promise of Cy superiority has been realized. Although certain naivete about the likely panacea property of Cy occurred early, major adjustments in the original immunosuppressive protocol were required and included the use of rescue ATG, the measurement of Cy levels in the blood, the use of less Cy, and the perioperative avoidance of Cy. We anticipate a continued 80% one year survival with a likely survival in excess of 66% at five years. Furthermore, it is believed that the avoidance of early nephrotoxicity combined with the use of less Cy chronically will result in far fewer problems with nephrotoxicity. While we have been conservative with our immunosuppression, we have aggressively broadened the criteria for candidacy to include patients mortally ill, patients with elevated pulmonary vascular resistances, and those in their sixth decade. We believe that challenges for the future will include the development of selective immunosuppressants and coordinated networks for donor procurement so that more patients will have the opportunity for cardiac replacement.