thesis
Rejection Pathways in Heart Transplant Recipients
- Publication date
- 17 February 1999
- Publisher
- Since the beginning of this century experimental heart transplantations in animal
studies were performed.' These studies were started in Rotterdam in the seventies
to compare heterotopic and orthotopic heart transplantations, and to study the
process of chronic rejection.
The history of the first human heart transplantation started in South-Africa and it was
carried out by Barnard in 1967. Several cardiac surgeons around the world initiated
new transplantation programmes. However, the problems with patient and donor
organ selection as well as with immunosuppression, severe rejection and infection
were common. This meant in 1968, only 22% of all transplants survived after the first
year.6 Consequently, many centres stopped their programmes.
Heart transplantation, as a routine treatment for organ failure, only became possible
with the development in 1973 of the endomyocardial biopsy technique for monitoring
acute rejection? and in 1975 by the further discovery of cyclosporin A. In the early
eighties cyclosporin A was successfully introduced as an immunosuppressive
medicine post clinical heart transplantation.' Cyclosporin A acts by binding to
calmodulin and thereby inhibits the transcription of the IL-2 and IFN-y gene." With
the development of these new processes, a 50% survival rate after 5 years was
achieved in 1982.