ABSTRACT
In 1905, the innovative French surgeon Alexis Carrel performed the first heterotopic canine heart transplant with Charles Guthrie.1 Twenty years later, the concept of cardiac allograft rejection was proposed by Frank Mann at the Mayo Clinic to explain the eventual failure o f heterotopic canine allografts. He described the rejection process as the biologic incompatibility between donor and recipient manifested by an impressive leukocytic infiltration of the rejecting myo cardium.2 The first human heart transplant was a chimpanzee xenograft performed in 1964 by James Hardy at the University of Mississippi. Although the surgical procedure was technically satisfactory, the heart was too small to maintain independent circulation and functioned for only 90 minutes before failing.3 On December 3, 1967, South African Christiaan Barnard surprised the world when he successfully performed the first human-to -human heart transplant. Unfortunately the recipient, Mr. Louis Washkansky, died 18 days later of pneumonia.4 By the end of 1968, over 100 patients had received heart transplants at 50 different institutions in 17 countries around the world. The results of these early transplant programs were generally miserable and were perceived as premature experiments by the medical community and the public. During the 1970 s, only a few institutions continued clinical cardiac transplantation, with Dr. Norman Shumway leading the way at Stanford. During that decade, the 1-year survival after transplantation increased from 22% to 65%.5,6 In 1973, Philip Caves redeveloped the transvenous endomyocardial bioptome which finally provided a reli able means for monitoring allograft function and rejection.7 In 1981, the advent of the immunosuppressive agent cyclosporine dramatically increased patient survival and marked the beginning of the modem era of successftd cardiac transplantation. Transplantation is now a widely ac cepted therapeutic option for patients with end-stage cardiac failure.
