This month marks 50 years since surgeons at Stanford University placed the heart of a 43-year-old man in a 54-year-old patient — the first adult heart transplant performed in the United States. That surgery followed the world’s first human heart transplant performed one month earlier in Cape Town, South Africa. In both cases, the heart recipient survived for just over two weeks.
It would take more than another decade before the development of better anti-rejection drugs made transplantation more viable. Today, cardiac transplantation is a standard option of care in the treatment of end-stage heart disease, due largely to advancements in immunosuppressive medications. But to stay active and healthy, transplant patients require lifelong care from a well-trained cardiologist.
Howard Eisen, MD, Chief of the Division of Cardiology at Drexel University College of Medicine, is one of those physicians. He has cared for more than 1,200 transplant patients throughout his career and was recently named one of the “27 Top Cardiologists” in the country (the only one in Pennsylvania), as reported by Forbes. In December, he was one of two American cardiologists invited to Cape Town to speak at a symposium commemorating the anniversary of the first heart transplant.
“I’ve cared for some patients for more than 20 years,” Eisen says. “Transplant cardiology is the ultimate personalized medicine.”
He talked to us about why heart transplant recipients are living longer and what advancements in heart health are on the horizon.
What is the role of a cardiologist in the care of a transplant patient?
Our job is to evaluate patients before surgery and to manage their care following the transplant. Immunosuppressive drugs can cause new diseases and complications, and so there are many factors we have to evaluate — including pulmonary function, kidney function, blood pressure, white blood cell count, cholesterol and infectious diseases. A lot of it is like a shot in the dark; you have to figure out what works and what doesn’t, and then adjust medications and dosage accordingly. It can be very complicated.
How have medical advancements improved the outcomes of heart transplant recipients?
Cyclosporine, which was discovered in 1971, revolutionized heart transplants in the 1980s. It was the first immunosuppressive drug that regulates T cells without excessive toxicity. Throughout the years immunosuppressants have become stronger and less toxic, and have been replaced by better medications. We now use moderate doses of three different drugs – called triple therapy – and we eventually wean people off of corticosteroids, which minimizes side effects. We also have newer medicines that can prevent transplant coronary disease, and we use gene expression profiling test to find out when patients are at risk of rejection.
What is currently the biggest challenges in heart transplant surgery?
Donor shortage is still a big problem.
What are new advances in heart care coming down the pipeline?
New medications that make hepatitis C curable have made it possible to consider using infected organs for heart transplants. And with advances in gene editing — with CRISPR Cas9 — pig hearts may one day be used in a way that they could not transmit infections and are less of a target to the human immune system. Some researchers have also investigated using stem cells to grow hearts, but I think mechanical ventricular assist devices are likely to have the largest impact on saving lives – whether they’re used as a bridge to transplant or in place of one. [Note: Amy Throckmorton, PhD, an associate professor at Drexel’s School of Biomedical Engineering, Science and Health Systems, is developing an artificial heart designed specifically for infants, children and smaller adults.]
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