2018 marks the 50th anniversary of the first successful U.S. heart transplant, performed by Dr. Norman Shumway at Stanford University. That first patient survived just 15 days. Today, heart transplant recipients live for decades with their new hearts, thanks to advances in transplant science, antirejection drugs and post-transplant rehabilitation. Better therapies for patient’s noncardiac medical conditions have also contributed to improvements in outcomes.
Sharp Memorial Hospital was the first in San Diego to transplant a human heart successfully, on Oct. 11, 1985. Today, Sharp Memorial is recognized as a global leader in heart transplantation for its innovation and success, and has one of the country’s highest long-term survival rates. Sharp doctors have performed 426 heart transplants in the last 33 years.
Dr. Brian Jaski, a cardiologist affiliated with Sharp Memorial Hospital and a heart failure specialist who has been with the heart transplant team since its inception, recently reflected on the 50-year milestone.
How much of a risk were Dr. Shumway and his team taking when they performed that first transplant in 1968?
It took dedication and courage to initiate the heart transplant program at Stanford, because the risks were high. At that time, the one-year survival rate was only 40 percent. You have to keep in mind, however, that the survival of patients listed for transplant who didn’t get a heart transplant was less than 10 percent. Even though survival was not good at that time, it was still better than the patient’s survival would have been without this attempt.
The current national survival rates at one year and three years post-transplant are 91.4 and 85 percent, respectively. At Sharp, the one-year and three-year survival rates are 93.1 and 92.9 percent, as of January 2018 — among the highest in California, and the highest south of Los Angeles.
Why was post-transplant life expectancy so short in those early days?
We were limited in our ability to even recognize when an organ was undergoing rejection. An implanted heart had to fail again to recognize that the body was rejecting it. One huge leap forward was the ability to diagnose rejection before it failed by taking small fragments of heart muscle post-transplant and looking at them under the microscope. This allowed doctors to know what was happening at the cellular level before the heart began to fail.
We also didn’t have all the right medications to prevent transplant rejection. The next big breakthrough came after we understood organ rejection better, and the pharmaceutical industry developed the immunosuppressive drug cyclosporine, which allowed us to inhibit organ transplant rejection. Although it had some side effects, it was able to target the immune system components, rather than knocking the whole system down, and exposing patients to different health risks.
With these kinds of breakthroughs, Sharp was confident that the time was right for the people of San Diego to have their own heart transplant program, leading to the initiation of our program in October 1985.
How has the team at Sharp Memorial built upon those early innovations and pioneered cardiac research and care here in San Diego?
Before we started our program, Sharp had been by far the major cardiac surgery center in our region. We performed more coronary bypasses and more valve surgeries than any other hospital in San Diego. Our team was built on that expertise, and then we recruited cardiac specialists who had trained at some of the country’s top medical schools, like Dr. Robert Adamson, Dr. Peter Hoagland and myself, who were leading the way. With the foundation of an outstanding heart surgery program and the recruitment of people with expertise from these other medical centers, we then had the experience to expand into a new field.
Why is post-transplant rehabilitation so important?
The patient who has advanced heart failure necessitating a heart transplant has had chronic changes affecting every organ in their body, including the skeletal muscular system and circulation system. The human body is not designed to live with chronic heart failure. The cardiac rehab process, which was already in place when we started our heart transplant program, was ideally suited to help the patient after heart transplant. With activity, people can improve functionally and reverse the impairment of every other organ in the body. It’s been found that if people are enrolled in cardiac rehabilitation within the first six months after transplant, their long-term survival greatly improves.
What’s changed in 50 years of heart transplantation?
From the beginning, the cardiac team at Sharp recognized that we had to commit to taking care of the whole population of patients with heart failure at any stage, with therapeutic treatments for all. Even in 1985, people would wait months for a donor heart to become available. That time has extended to a year or more. We needed to address all of the factors that would prepare patients to be in the best shape they could be in before transplant.
One of the biggest developments that has become available has been the very reliable left ventricle assist device (LVAD). Patients, once they get them, can go home to recover their other organ function and strength, while they are awaiting transplant. For other patients, who may have other organ problems or who are not good heart transplant candidates, they can do very well with the LVAD, not just as a bridge to transplant, but as an alternative. That’s the biggest thing that has changed in clinical management of patients with heart failure since the late 1990s.
Sharp has been a leader in this area of cardiac care, led by Dr. Walter Dembitsky, clinical director of mechanical support programs. When the technology improved, so that people could go home with the LVAD, this led to a real era of expansion. At present, there are as many or more patients getting LVADs placed as heart transplants. This has really expanded the options we have for the care of patients with advanced heart failure.
Learn more about treatments for advanced heart failure at Sharp.
For the news media: To talk with Dr. Jaski about advances in cardiac care for an upcoming story, contact Erica Carlson, senior public relations specialist, at firstname.lastname@example.org.