Within the last three years, advances in the fields of cardiac surgery and immunology have established the value of cardiac transplantation for patients with irreversible myopathic disease. Long-distance donor procurement has increased the availability of the donor pool and made possible a more critical selection of donor hearts. The development of antithymocyte globulin and the concept of individual immune monitoring has decreased the incidence of acute rejection and the dosage of prednisone and azathioprine necessary to achieve optimal graft protection. These advances are reflected in the survival statistics. Since 1977, the three-month mortality rate has decreased to 40%, as compared to 77% from 1968 to 1976. Patients who are discharged from the hospital are currently demonstrating an 88% one-year survival rate and are functional class I-II status. We conclude that in properly selected patients, cardiac transplantation is a viable option for end-stage cardiomyopathic disease.
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