Learning objectives

  • To review the current indications and contraindications to listing for cardiac transplantation.

  • To review the necessary workup prior to listing for transplantation.

  • To understand the contemporary outcomes and long-term complications following cardiac transplantation.

  • Introduction

    Despite advances in medical and device therapy, the prognosis and quality of life of patients with advanced heart failure (HF) remains poor. For a carefully selected group of these patients, cardiac transplantation is the treatment of choice.

    The first human-to-human heart transplant was performed in Cape Town on 3 December 1967 by Christiaan Barnard; the patient died 18 days later of infective complications. Outcomes were poor in the early years, but with the discovery of ciclosporin in the 1980s there was an improvement in survival which led to a peak in cardiac transplant activity in the early 1990s.1

    Between 1993 and 2004, there was…

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