Heart Transplantation - Part II: Aspects of Procedure and Medical Management

Ischemic time, defined as the period from donor procurement to surgical implantation and restoration of intrinsic allograft function, is an independent risk factor for post-transplant mortality. In general, the ischemic time should be less than 4 hours.  Most programs will accept donor hearts from within their own UNOS region or within a radius of 500 to 1000 miles to minimize ischemic time.  Given the prevalent use of ventricular assist devices (VAD) as bridge to transplant and the increased time required to explant both the native heart and VAD hardware, patients must live within 2-3 hours (by car or air) of the transplant center.  Coordinating the donor harvest and recipient preparation requires close collaboration between multiple surgeons, surgical teams and coordinators. This review contains 11 figures, 7 tables, and 52 references. Key words: heart transplant, immunosuppression, allograft rejection, infection, hypertension, hyperlipidemia, diabetes, malignancy, cardiac allograft vasculopathy, survival