Foreword

Heart transplantation became a clinical reality in 1967. While initially the results were more than questionable and many teams gave up after a few cases, the systematic and persisting work of the Stanford group around the late Norman Shumway accumulated almost all the knowledge and progress during the 1970s which allowed a new start to be made by many teams in the early and mid-1980s, with increasingly good early- and long-term results. Heart transplantation has stimulated many fields in medicine, ethics and legal considerations and must be considered one of, if not the most, outstanding medical achievement of the twentieth century.

Today more than 80 000 heart transplantations have been performed worldwide, the mean survival of transplanted patients has risen to 12 years, and there are now many patients who have survived with fairly good quality of life for more than 20 years. Some recipients of my own surgical activities have now lived for up to 25 years after transplantation, and there are some patients transplanted in Stanford who have lived for almost 30 years and enjoyed a fairly good life.

The question has been raised why some patients are fortunate enough to have such a long and event-free life, some despite only minor immunosuppression, and why many others do not. Quite obviously the long-term survivors have developed a kind of tolerance towards the transplanted organ and many also seem to be protected from transplant coronary artery sclerosis and from immunosuppressive side effects.

These questions have not been answered. Clearly the answers must lie hidden in the amount of congruence of factors, most likely of a genetic nature, between the recipient and the donor. This, however, has not been studied systematically. At present we are collecting the experience of the various groups that started heart transplantation sufficiently long ago to have patients who have lived for longer than 20 years, and we are curiously listening to their opinions relative to the aforementioned questions.

The symposium that we organized in Berlin from 21–22 June 2008 focused on this topic and was able to bring together representatives of some of the groups interested in this important field. The proceedings of the symposium are compiled in this volume. The contents may raise further interest and may also contribute to more insights.

I am grateful to all contributors for coming to Berlin and sharing their findings and their thoughts with us. I would like to thank Mrs. Sabine Hübler, our Studies Center Coordinator, and her team for organizing the symposium and I am indebted to Roche Pharma AG for their support, without which we could not have come together, and also for financing the printing of this symposium volume.

Prof. Dr. R. Hetzer