The postsurgical heart. The pathology of cardiac transplantation.

Cardiac transplantation offers an excellent chance of long-term survival and functional rehabilitation for the carefully selected patient with end-stage heart disease. The role played by the pathologist in the management of cardiac transplant recipients is a very important one. Although much work is being carried out currently on noninvasive procedures to predict acute rejection, at this time the morphological index of rejection by endomyocardial biopsy is still the only reliable one. Noninvasive techniques are more sensitive because the whole heart can be studied; however, they are still much less specific and cannot distinguish infection from rejection or ischemia. The current management and survival of cardiac allografts depends as much on the pathologist as on his clinical colleagues.