More than 25 years have elapsed since the first heart transplantation took place. It was a brave effort, and the first step into what was then brand-new technology. Since then, an enormous amount of work, and more than 250 million in research in America alone, has now brought heart transplants to a sophisticated, successful state-of-the-art operation. The major improvement came with the development of cyclosporine A, a special drug that virtually prevented tissue rejection, until then the chief cause of failure.
Cardiac transplantation has become a regularly performed surgical procedure for patients with end-stage heart disease. These are patients who had exhausted all medical and surgical options. Once viewed as a clinical experiment, transplantation has now emerged as a cost-effective therapy that improves both quality and length of life of the recipient. Studies have confirmed that there is a benefit in costs to the patient’s family network and to the community as a whole, the Medical Journal of Australia reported recently. However, it still remains an evolving high technology procedure.
Cyclosporine A, azathioprine and prednisolone have been used as the major antirejection drugs. But the new OKT3, a monoclonal antibody, is the newest step forward in treatment. By using a combination of drugs it means that smaller doses are needed, reducing the adverse side effects that accompany large doses of any single drug.
The limited supply of donor organs remains the most restricting factor at present. This is the case in Australia, New Zealand and in cardiac units around the world. In the United States, around 30,000 people die annually from end stage heart disease. At the same time 2000 or so hearts become available for transplant, so the deficit is enormous.
As an interim measure, a new technique called the “bridges-to-transplantation” is being used more frequently. Patients are given an artificial heart. (This is based on the Jarvik-7 device used in the mid 1980s, but unsuccessful as a long-term device.) It is aimed at keeping patients alive until a suitable donor organ becomes available, and it appears to be successful in up to 80 per cent of patients.
The procedure is not without its cost. “The cost of cardiac transplantation varies with individual patients. In Australia, the average cost is approximately $75,000. This includes the pretransplantation assessment, the operative procedure and in-hospital care,” the Medical Journal of Australia says. “The contribution of cyclosporine A to these costs is approximately S7500 a year.” Once again, the limited supply of donor hearts acts as cost containment.
In America with its astronomical medical costs, treating a terminally ill cardiac patient costs about SUS2000 a month. -The costs of convalescence for a cardiac transplant recipient are somewhat lower and the ‘investment’ results in survival of 70 – 75 per cent of recipients at five years after the operation.” the Journal says. Medium and long-term results of transplant are gratifying, surgeons say.
Most patients return to normal exercise capabilities, and are fully rehabilitated to active and productive lifestyles. In the Australian programs, about 70 per cent of recipients return to work, study or home duties.
The next stage forward is replacement of lungs and heart. Most have been carried out in Britain and America, some in Australia, and it is now considered to be the latest hurdle to clear to help patients with both heart and lung problems. It is an exciting time. The results are improving. The outlook seems promising.