Of course, there are alternative futures to the field of heart transplantation that may include the application of total mechanical support, stem cells, or bioengineered whole organs. It could also advance the field of pig-to-human xenotransplantation, which, if successful, would eliminate the organ shortage problem. Understanding why organs like kidneys and livers are prone to tolerance induction, whereas others like hearts and lungs are tolerance-resistant, could aid in our attempts to achieve long-term, immunosuppression-free survival in human heart transplant recipients. However, the heart, as opposed to other allografts like kidneys, appears to be a tolerance-resistant organ. Most, if not all, of these obstacles to long-term survival could be prevented or ameliorated by the induction of transplant tolerance wherein the recipient’s immune system is persuaded not to mount a damaging immune response against donor antigens, thus eliminating the need for chronic immunosuppression. In addition, over the last decade, new challenges have arisen such as increasingly complicated recipients and antibody-mediated rejection.
This is mainly due to chronic rejection, malignancy, and the detrimental side effects of chronic immunosuppression. However, there has been little change in long-term outcomes. The 1-yr survival rates following heart transplantation have improved from 30% in the 1970s to almost 90% in the 2000s. There has been significant progress in the field of heart transplantation over the last 45 years.
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