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To Your Health: NLM update Transcript

Heart transplant lessons: 02/20/2018

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine (NLM).

Here is what's new this week in To Your Health, a consumer health oriented podcast from NLM, that helps you use MedlinePlus to follow up on weekly topics.

A new perspective on the success of the half-century-old history of heart transplants is provided in a viewpoint recently published in the New England Journal of Medicine.

Shelley McKellar Ph.D., a medical historian, explains the first heart transplant was performed in December 1967 by South African surgeon Christiaan Barnard M.D. McKellar reports the operation was enthusiastically reported globally by the news media and generated simultaneous clinical envy and excitement. McKellar notes by the end of 1968, or just a year after Barnard's original surgery, physicians had performed about 100 heart transplants in several countries.

However, McKellar finds none of the early heart transplants was successful; the men and women recipients of varying ages did not survive long after the operation.

McKellar writes (and we quote): 'By the end of 1968, mounting medical criticism and poor patient outcomes deterred many cardiac specialists and patients from pursuing heart transplantation. Though surgeons might have the technical competence to transplant hearts, critics saw the procedure as premature; there was inadequate immunological knowledge to prevent organ rejection, and there were not alternative means to sustain life in the event of failure' (end of quote).

Unsurprisingly, McKellar explains the American College of Cardiology advanced an unofficial moratorium on heart transplants in 1970.

McKellar, who spoke at an NLM lecture honoring the late heart surgeon Michael DeBakey M.D. last spring, adds that thanks to surgical and other improvements, the number of heart transplants increased to 844 by 1985. Thereafter, McKellar notes the availability of new anti-rejection drugs significantly improved patient outcomes.

In fact, McKellar reports there were 5000 heart transplants performed internationally in 2015.

While the initial public and clinical enthusiasm in the late 1960s quickly turned to skepticism, McKellar suggests a half century of heart transplants should be perceived as a medical success story rather than a cautionary tale.

McKellar, Western University in Canada, writes (and we quote): 'clinical firsts are rarely definitive junctures of success or failure, but rather are key moments in an innovation process that is iterative and cumulative. The early heart transplantations contributed clinical knowledge, identified knowledge gaps, and generated debate' (end of quote).

Despite the initial disappointment of heart transplants, McKellar writes (and we quote): "what persisted was the desire to save lives and the commitment to rebuilding patients' bodies in the fight against disease' (end of quote).

Meanwhile, the American Society of Transplantation's website about receiving a new heart is accessible in the 'start here' section of MedlinePlus.gov's heart transplantation health topic page.

The International Transplant Nurses Society provides a guide to health care after a heart transplant that is available in the 'living with' section of MedlinePlus.gov's heart transplantation health topic page.

MedlinePlus.gov's heart transplantation health topic page additionally provides links to the latest pertinent journal research articles, which are available in the 'journal articles' section. Clinical trials that may be underway in your area are accessible in the 'clinical trials' section. You can sign up to receive updates about heart transplantation as they become available on MedlinePlus.gov.

To find MedlinePlus.gov's heart transplantation health topic page, please type 'heart transplantation' in the search box on MedlinePlus.gov's home page, then, click on 'heart transplantation (National Library of Medicine).' MedlinePlus.gov also has health topic pages devoted to: cardiac rehabilitation and heart failure.

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It was nice to be with you and best wishes for the new year. Please join us here next week and here's to your health!