Cardiac transplantation. Changing patterns in evaluation and treatment.

This study reports the authors' experience with 66 heart transplants in 64 patients done over an 8-year period (1977-1985). In the early series, a high frequency of complications involving serious infections was noted. In April 1983, the immunosuppressive regimen was changed to cyclosporine and low-dose steroids. Patients were monitored with frequent myocardial biopsies and determinations of serum cyclosporine levels. Although this is not a controlled study, the authors believe that the improved results, including reduced frequency and severity of infections, are related to altered immune suppression. They speculate that patients with successful cardiac grafts develop a form of specific unresponsiveness and now are studying the mechanisms of this adaptation.