Heart transplantation surgery has advanced significantly since the first successful transplant in 1967. However, it is still considered a “last resort” when treating heart conditions.
“Our goal is to keep patients alive and healthy with their own heart, with the use of medications, or other assist devices. Transplantation really is the last option. And, transplantation is not a perfect treatment. A transplanted organ does not last forever,” states Dr. Wally Carlo, Associate Professor at the University of Alabama at Birmingham and Medical Director of the Pediatric Advanced Heart Failure and Transplant Program at Children’s of Alabama.
Instances where transplantation is appropriate include:
- Patients who are born with congenital heart conditions and have undergone multiple operations, but their heart is giving out and there is no further surgery available to them.
- Patients who have previously been healthy children and teenagers and suddenly present with the first symptoms of a weakened heart or cardiomyopathy they may have had for years—but had not demonstrated any symptoms until that time.
- Patients who have acquired a new infection of the heart.
- Babies born with very rare conditions that are not amenable to surgery or conditions wherein the heart muscle is very weak.
Surprisingly, infants tend to have a very forgiving immune system. “An infant transplanted successfully in the current era should be expected to have at least a 25-year graft survival, meaning we would expect them to be benefitting from that transplanted organ for two or three decades. Then, at that point, 25 years from now, we may have new options to treat them,” explains Dr. Carlo.
Risks of Post-Transplantation
Post-transplant is a precarious time for heart recipients. Transplant patients require immunosuppressive medications to help the body not reject the organ. Unfortunately, at the same time, those medications set patients up to potentially develop infections their body cannot fight off, cancers, or other complications.
It’s important for patients and family members to understand the potential risks. Dr. Carlo assures this information is presented in a way that does not put extra strain on the family—it’s all about education.
“We really want families to enter transplantation being fully informed of the risks that come along with this treatment strategy. It’s a really involved process that requires a thorough evaluation of the patient and the family. We get to know them; they get to know us. And they get to really learn all about transplantation and what it entails, because it is a life changing therapy.”
Heart Transplant Innovations
The transplant team at Children’s is currently studying different immune system therapies done at the time of transplantation to try to better understand patient outcomes in the first year after transplant. Additional research takes a look back at transplant outcomes to learn who is benefitting the most from various immunosuppressive strategies after transplantation.
Children’s is also participating in a multicenter trial involving a group of approximately 10 institutions. The trial is studying muscle injections of stem cells into the right ventricle. The goal is that the stem cells will stimulate the right ventricle to become stronger, or to remain stronger, for a longer period of time in patients who suffer from hypoplastic left heart syndrome (HLHS).
“Hypoplastic left heart syndrome patients make up an important number of our transplant candidates, and we would love to have a way to reduce the number of those patients coming to us throughout their life. If we could help keep the function of their right ventricle better for a longer period of time, those patients will have a better quality of life and duration of life,” notes Dr. Carlo.
“We have a fantastic team. We average about nine to ten transplants per year. We would love for children to be healthy and not need any transplants. But, we are there for them and their families, and I think we provide a really tremendous service,” shares Dr. Carlo. “We also have events throughout the year where we support organ donation and try to get the word out about the importance of increasing the organ pool, so that our patients have a better chance at getting the therapy they need.”
To listen to an interview on this topic with Dr. Wally Carlo, Associate Professor at the University of Alabama at Birmingham and Medical Director of the Pediatric Advanced Heart Failure and Transplant Program at Children’s of Alabama, follow this link: https://radiomd.com/childrensalabama/item/41779