ABSTRACT
Cardiac transplantation is the gold-standard treatment for patients with advanced heart failure. Despite an increasingly higher-risk recipient population, as well as the more prevalent use of mechanical support bridging to transplant, the overall survival after cardiac transplantation continues to improve. Orthotopic cardiac transplantation is indicated for patients with advanced heart failure that is refractory to medical therapies and/or conventional surgical treatments. The conventional indications for heart transplantation include systolic heart failure, ischemic heart disease with intractable angina not amenable to revascularization, intractable dysrhythmias, hypertrophic cardiomyopathy not amenable to surgical or percutaneous therapies, congenital heart disease with diminished ventricular function, and isolated cardiac tumors. Primary graft failure is an uncommon but devastating event after heart transplantation that occurs in up to one-quarter of patients. The published rate of primary graft dysfunction varies by definition: 2.3% (death or re-transplant) to 27%. Antibody-mediated rejection (AMR) is due to anti-HLA donor-specific antibodies in the recipient.
