heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in humans was done in 1967 and the first cases in Korea was performed in November,
1992.
Since
the first case in 1992, more than 50 cases have been performed in Korea. A total of 20 patients underwent orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The purpose of this study is to evaluate the early results and
the
follow-up course of 20 cases of heart transplantation done in Asan Medical Center. The average age of 20 patients was 39.9±11.8 years old(20~58). The mean follow-up duration was 14.4±11.2 months(1~41). All patients are alive till now. The blood
type
was identical in 14 and compatible in 6 patients. The original heart disease was dilated cardiomyopathy in 16, valvular heart disease in 2, ischemic cardiomyopathy in 1, and giant cell myocarditis in 1 patient. HLA cross matching for recipient
and
donor
was done in 18 cases and the results were negative for T-cell and B-cell in 16 patients, postive for warm B-cell in 2 patients. Among 6 loci of A, B, and DR, one locus was matched in 8 cases, 2 loci in 5 cases, and 3 loci matched in 1 case. The
number
of acute allograft rejection averaged 2.8±0.5(0~6) per case and the number of acute allograft rejection requiring treatment averaged 1.0±0.9(1~3) per case. The time interval from operation to the first acute rejection requiring treatment was
35.5±20.4 days(5~60). Acute humoral rejection was suspected strongly in 1 cases and was successfully treated. The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 17.5±6.8(9~32)%
to
58.9±2.0(55~62)% after heart transplantation. Temporary pacing was needed in 5 patients over 24 hours but normal sinus rhythm appeared within 7 days in all cases. One patient has been taken permanent pacemaker implantation due to complete AV
block
appearing 140 days after heart transplantaion. One patient had cyclosporine-associated neurotoxicity during the immediate postoperative period and was recovered after 27 hours. The heart transplantation of Asan medical Center is on a developing
stage
but the early result is comparable to that of well established centers in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in patients
with
terminal heart failure.
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