2 The heart transplant and VAD program at St Vincent’s hospital, sydney

2018 marks the 50th anniversary of heart transplantation at St Vincent’s Hospital in Sydney. The modern era of heart transplantation for our institution commenced in 1984 and since then the programme has performed >1000 heart transplants (HTx), >1000 lung transplants and almost 100 combined heart-lung transplants. Bridge-to-transplant ventricular assist device (VAD) support began in 1994 with the pulsatile Heartmate 1 device with a transition to continuous flow VADs in the mid 2000s. Current activity is 20–25 VADs, 40–50 HTx and 50–60 lung transplants per year. Over the last 3 decades, there has been an increased utilisation of marginal donors including older DBD donors and more recently DCD donors.1 The latter has been facilitated by utilisation of normothermic machine perfusion (NMP) for donor heart retrieval and transport.2 Donor hearts retrieved using NMP now account for 20% of all HTx. This proportion is expected to increase in the future. There have also been major changes in recipient characteristics with increased referral of older patients with advanced heart failure. Assessment of physical frailty together with cognition and depression are now routine for all patients referred for HTx assessment.3 4 There has also been an increased reliance on bridge-to-transplant VAD to support patients to transplantation. Despite these changing donor and recipient characteristics, post-transplant survival remains excellent with a median survival of almost 15 years. HTx remains the most effective therapy for advanced heart failure but is limited by availability of suitable donors. Improvements in donor heart preservation are expected to further increase the availability of this life-saving therapy. References Dhital K, Iyer A, Connellan M, et al. Distant procurement orthotopic heart transplant from donation after circulatory death. Lancet 2015;385:2585–2591. Macdonald PS, Chew HC, Connellan M, Dhital K. Extracorporeal heart perfusion before heart transplantation: The heart in a box. Curr Opin Organ Transplant 2016;21:336–342. Jha S, Carter D, Hannu MK, et al. Frailty as a predictor of outcomes in transplant eligible patients with advanced heart failure. Transplantation 2016;100:429–436. Jha S, Carter D, Hannu MK, et al. Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. J Heart Lung Transplant 2016;35:1092–1100.