Vnitr Lek 2004, 50(Supplement 1):S115-S121

[New horizons in heart transplantation].

L Spinarová: I. interní kardioangiologická klinika Lékarské fakulty MU a FN U sv. Anny, Brno.

Since its beginning in 1967 heart transplantations have become in 80s of the 20th century a routine treatment method of an advanced heart failure. In spite of the successes in transplantations a range of possible topics and research goals still has to be disclosed to improve quality of life and survival of patients. New horizons in heart transplantations can be summarised in following points: 1 Search of new more efficient immunosuppressives with less adverse effects. Classically a combination of Cyclosporin, Azathioprin, and corticoids have been used. Mycophenolate mofetil starts to be used in treatment instead of Azathioprin, Tacrolimus has been introduced as a drug for resistant rejections and also Rapamycin or Baziliximab are planned to be used in future. Use of Rapamycin seems desirable in patients suffering from nephropathy because it makes possible to lower doses of Cyclosporin or Tacrolimus or to stop taking them. 2 Diagnostics of rejection episodes without endomyocardial biopsy. From noninvasive methods echocardiography methods are looked for--tissue doppler imaging, densitometry, contrast echocardiography, strain and strain rate or assessing levels of some of the humoral agents: interleukin, cerebral natriuretic peptide or troponin T or direct assessment of donor DNA release in receptor's blood. 3 Earlier diagnostics of vasculopathy (here intravascular ultrasound is possible to use), particularly its pharmacology prevention. Statin treatment has been preventively introduced. 4 Xenotransplantation as a possible way of a heart replacement with an animal heart. Progresses in gene engineering lead to a development of transgenic animals, particularly pigs, with human proteins inserted in their genome and regulating activation of immune system. This way hyperacute rejection could be prevented. A range of unclear questions still remains in this area, particularly ethical ones and a risk of animal diseases transfer onto a human together with transplanted tissue. 5 Transplantation of cells from skeletal muscles (myoblasts) or marrow stem cells. 6 Development of apparatuses able to substitute heart function--total artificial heart. However, a range of questions is still unanswered in this area: a suitable material or source for long-term operation is needed to be found. Heart transplantation has become in last two decades a well-established treatment method of a serious heart failure. In spite of numerous difficulties it extends life of patients and improves its quality. Future will show whether we are able to replace it with other procedures.