Like Indiana Jones on a crusade, doctors are on a quest for the holy grail of heart transplantation — and are gettingclose.
Advancements in anti-rejection drugs that have fewer severe side effects, longer survival rates for pediatric and adult heart transplant patients, and new devices are a few of the steps forward in treating patients with coronary heart disease and other defects. Many of the advancements are taking place at institutions like Miami-Dade’s Jackson Memorial Hospital and University of Miami, and Broward County’s Memorial Healthcare and the Cleveland Clinic.
“The best of all worlds is when we put in a heart transplant, or any organ, and some way induce the body to accept that organ without anti-rejection medications. That is the holy grail of transplantation and is something we have been working on for years, including myself in the research area, and we see the end of the tunnel now,” said Dr. Si Pham, chief of the Division of Heart and Lung Transplantation at the University of Miami Miller School of Medicine.
Heart transplantation, first performed successfully on an adult by South African cardiac surgeon Christiaan Barnard in 1967, gained traction in the 1980s. The United States leads the world in number of transplants performed — about 2,000 or more per year, according to the International Society of Heart & Lung Transplantation (ISHLT). But the procedures aren’t rising significantly because donors with suitable hearts remain in limited supply.
Jackson began performing heart transplants in 1984 and performs 27 to 30 annually.
“The reasons for the small numbers are that in our society heart disease is quite prevalent,” Pham said. “Even a 70-year-old can donate a kidney or liver, but not a heart because of coronary heart disease. Most of our donors come from a limited pool of younger donors who don’t have heart disease.”
Memorial Regional’s Joe DiMaggio Children’s Hospital performed its first heart transplant in December 2010 and has transplanted eight since, said Dr. Maryanne Chrisant, medical director of the heart transplant and cardiomyopathy programs. “Cardiac transplantation is still regarded as not experimental but certainly more extreme care, and it may not be the right therapy for everyone or every family,” she said.
The average waiting period for a patient to receive a new heart is about two to three months, Chrisant said, but the wait can extend to six months or more.
Chrisant cited figures on the half-life for patients who have received heart transplants — meaning how long the transplanted heart will function properly before requiring another transplant. For infants, it’s about 19 years; for children 17 and under, about 16 years.
“These are kids who would have died without transplants and it doesn’t mean they will wake up in 12 years and the heart will conk out. It means folks receiving heart transplants should ‘take heart’ because there’s an opportunity to have a relatively normal life span.”
For adults, a new heart will last about about 13 years but varies. “If they are obese or diabetic, it’s likely — even post-transplant — they will have some issues. Put in context, kids are pretty good about living purely and not having bad habits. There is the potential to need another heart and we counsel parents about that and tell them about all the risks.”