Challenges in heart transplantation: now and the future.

Little more than 30 years after the first human operation, heart transplantation continues to be the gold standard treatment for heart failure disease. During these years, surgical procedures and immunosuppressive treatment have improved and the survival rate continues to improve despite transplanting older and sicker patients. However, there are still many challenges that we are currently facing. Regarding organ shortage, donor heart acceptance criteria have been reconsidered. Better donor management could increase the organ pool, maximizing the use of hearts recovered from cadaveric donors. Concerning organ allocation, recent improvements in medical treatment could restrict transplantation procedures to the patients at greatest risk of dying. Controlling allograft rejection, vasculopathy, and malignancies are current challenges. Cyclosporine, azathioprine, and corticosteroids have been the mainstay of immunosuppression, but carry severe adverse systemic effects. Today, new pharmacologic agents have become available and hold the possibility to improve the length and quality of recipient life.