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Heart transplantation (HTx) stands as a life-saving intervention for patients with end-stage heart disease, but the field is fraught with numerous challenges that span from the scarcity of donor organs to long-term complications arising from immunosuppressive therapies. This comprehensive review article offers an in-depth exploration of the multifaceted aspects of HTx. The review covers groundbreaking advancements in xenotransplantation, enabled by cutting-edge genetic engineering techniques, and the promising role of stem cell therapies, particularly porcine mesenchymal stem cells, in cardiac regeneration. It also delves into the evolution and limitations of immunosuppressive therapies and the revolutionary potential of artificial intelligence (AI) and machine learning (ML) in enhancing donor-recipient matching and predicting patient outcomes. Economic considerations, especially in the context of rising healthcare costs, are examined to assess the sustainability of these advancements. The article further discusses the significant improvements in patient outcomes over the years, while highlighting persisting challenges, such as graft failure, rejection, and infection. It underscores the importance of experience and specialized training, evidenced by the presence of an institutional learning curve. The review concludes by advocating for a multifaceted, collaborative approach involving clinicians, researchers, and policymakers to overcome existing challenges. Through coordinated efforts that consider medical, ethical, and economic factors, the field of HTx is poised for further evolution, offering renewed hope for improved patient care and outcomes.
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http://dx.doi.org/10.7759/cureus.46176 | DOI Listing |
J Thorac Cardiovasc Surg
September 2025
, Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA; , Department of Regenerative Medicine Research, Texas Heart Institute, Houston, Texas, USA. Electronic address:
Objective: Celsior solution (CS) is used for cold preservation of hearts from brain death donors but not for those from circulatory death donors (DCD). Plasma membrane repair proteins are crucial for maintaining myocardial integrity during ischemia. We compared the effects of CS cold preservation with normal saline (NS) on myocardial membrane disruption and pyroptosis in human DCD hearts, with varying warm ischemia times (WIT) and cold storage durations.
View Article and Find Full Text PDFHum Immunol
September 2025
Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Heart transplant candidates that are highly sensitized against human leukocyte antigens (HLA) face ongoing challenge in finding immunologically compatible donors. Desensitization strategies aimed at reducing HLA antibody titers have variable success rates. Imlifidase, a novel immunoglobulin G-degrading enzyme derived from Streptococcus pyogenes has been successfully used to eliminate pre-formed antibodies in sensitized kidney transplant recipients.
View Article and Find Full Text PDFJ Allergy Clin Immunol
September 2025
National Heart and Lung Institute, Imperial College London, London, United Kingdom; Frankland and Kay Allergy Centre, UK NIHR Imperial Biomedical Research Centre, United Kingdom.
Recent advancements in genomics and "omic" technologies have ushered in a transformative era referred to as personalized or precision medicine. This innovative approach considers the unique genetic profiles of individuals, along with a range of variability factors, to devise tailored disease treatments and prevention strategies that cater to the distinct needs of each patient. Although the terms personalized medicine and precision medicine are frequently utilized interchangeably, it is essential to delineate the subtle distinctions between them.
View Article and Find Full Text PDFJ Heart Lung Transplant
September 2025
Professor of Pediatrics and Immunology, Director Pediatric Cardiac Transplantation, University of Alberta / Stollery Children's Hospital, 4C2.24, Walter MacKenzie Center, 8440 - 112 Street, Edmonton, AB, T6G 2B7. Electronic address:
Am J Med Sci
September 2025
Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Background: Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is now the second leading indication for liver transplantation (LT) worldwide and is associated with increased risk of cardiovascular events before and after LT. Cirrhotics who undergo left heart catheterization (LHC) with coronary artery stenting for LT evaluation require dual-antiplatelet therapy (DAPT). Data regarding the safety, risk of gastrointestinal (GI) bleeding, and mortality risk of cirrhotics receiving DAPT is limited.
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