Heart Transplantation in Taiwan

Taiwan performed the first successful clinical heart transplantation on July 17, 1987 By Aug 31, 2008, there were 838 patients received heart transplantation. All patients underwent orthotopic heart transplantation, except for 13 heterotopic transplants including one with two donor hearts in one chest. Among the 377 cases of transplant performed at the National Taiwan University Hospital and the Far Eastern Memorial Hospital,the ages ranged from 5 months to 70 years old with a mean of 47 years, the etiology of heart disease included dilated cardiomyopathy in 51%, ischemic cardiomyopathy 30%, valvular heart disease 8%, and others 11%. Because of shortage of donor, marginal donors were used Extracorporeal membrane oxygenation, ventricular assist device and Batista operation were used for bridging to heart transplantation. Thirteen patients underwent simultaneous kidney and heart transplantations After heart transplantation triple therapy with cyclosporine or Tacrolimus, azathioprine or cellcept and steroid were used OKT3, or antitymhocyte globuline were used as induction therapy or in patients with impaired renal function or severe acute rejection resistant to methylprednisolone. The late mortality was mainly due to cardiac allograft vasculopathy, sudden death, infection, and neoplasm Cardiac allograft vasculopathy and neoplasns were less than those of western countries. For 216 cases of heart transplants done at the National Taiwan University Hospital for the last ten years the operative mortality was 8.0%. The actuarial I year, 5 year and 10 year survival rates for adults were 82 +/- 2%, 67 +/- 3%, and 56 +/- 5%, respectively. The pediatric group had better survival rates than adult. In conclusion, heart transplantation in Taiwan has been well established as a routine procedure for selected patients with end-stage myocardial failure and the results are comparable to the western countries.