Cardiac transplantation: the UCLA experience 1984 to 1990.

The international experience has documented the therapeutic value of cardiac transplantation in the management of carefully selected patients with endstage heart disease. The UCLA program's experience over the years 1984 to 1990 mirrors these results, establishing heart transplantation as an accepted form of therapy that offers extended survival and improved quality of life compared to alternative means of treatment. Criteria of eligibility for recipient candidates have become less restrictive, most notably the expansion of age limits to include increasingly older patients.

Heart transplantation may not improve quality of life for patients with stable heart failure.

Heart transplantation is a therapeutic option for many patients with end-stage heart failure. Vigorous medical therapy has evolved so that many patients eligible for heart transplantation can now be discharged and stabilized with medical therapy. Heart transplantation improves survival, but it has not been compared previously with sustained medical therapy with regard to quality of life.

Randomized study of high dose oral cyclosporine therapy for mild acute cardiac rejection.

Mild acute rejection progresses to moderate rejection in approximately one third of the cases. Standard rejection therapy would then be instituted with the attendant risk of infection and other side effects. We randomized 40 episodes of mild acute rejection (20 episodes in each group) to receive no additional therapy or to have the oral cyclosporine dose increased for 7 to 10 days with repeat endomyocardial biopsy performed.

Mitral regurgitation after cardiac transplantation.

The contribution of the left atrium to mitral valve competence was assessed using the model of altered atrial size and geometry created by atrial anastomosis during cardiac transplantation. Sixteen patients underwent Doppler and 2-dimensional echocardiography after orthotopic transplantation. Mitral regurgitation was present in 14 of 16 patients.