40 years of heart transplantation in Vienna - a success story

On March 5, 1984, a human donor heart was successfully transplanted for the first time in Vienna. Since then, an average of 40 to 50 heart transplants have been performed each year at Vienna General Hospital and MedUni Vienna, with a total of over 1,700 to date. "Vienna is one of the world's largest centers for heart transplants," explains Daniel Zimpfer, Head of the Department of Cardiac Surgery at MedUni Vienna and University Hospital Vienna. The Vienna center geographically covers Vienna, Lower Austria, northern Burgenland and large parts of Upper Austria and Carinthia. All infants who require a donor heart are also treated here. "On average, recipients of donor hearts are 50 years old, 75 percent of whom are male and 25 percent female," explains Zimpfer.

The patients who need a donor heart are getting older and older due to improved medication and treatment options. It is mostly cardiomyopathies, i.e. heart failure, that lead to patients needing a new heart, but also coronary heart disease. Less frequently, dysfunctional heart valves, congenital heart defects or storage diseases make a transplant necessary. "The average waiting time for a donor organ is six to nine months, but if patients are listed as highly urgent with Eurotransplant, this can be reduced to ten to 14 days," says Zimpfer. A quarter of patients receive an artificial heart, which also enables them to survive for years and bridges the waiting time for a donor heart.  

Leading center in the innovation of heart preservation
It often takes a long time for a heart to find its way from the donor to the recipient and from another hospital to University Hospital Vienna. Vienna has established itself as a leading center in the innovation of cardiac preservation. "A donor heart lasts a maximum of four hours outside the body," says Andreas Zuckermann, Program Director for Heart Transplantation at the Department of Cardiac Surgery at MedUni Vienna and University Hospital Vienna, describing the initial situation. Initially, the organs were disconnected from the bloodstream, cooled in simple transport boxes and transported to the transplant center within a few hours in order to be implanted as quickly as possible. In 2007, the so-called Organ Care System was used for the first time in Vienna. This involves mechanical flushing with a blood-like solution at body temperature to ensure that the donor organ is preserved for longer and is less damaged. "At MedUni Vienna, we are constantly researching systems that help donor hearts reach their recipients in the best possible condition," says Zuckermann. The latest developments are ex-vivo preservation systems that keep the heart beating.

Postoperative management increases success rate
Successful transplants require a multidisciplinary, well-coordinated team. Patients receive comprehensive intensive medical care before and after the surgical procedure. The role of the medical team and the nursing team in the immediate post-operative care of heart recipients is particularly important because the donor heart has to adapt to the new, often completely different circulatory situation after removal and transportation. Drug support for the donor heart and treatment of the usually pre-existing pulmonary hypertension begins intraoperatively by the anesthesia team and requires a high level of expertise in complex cardiovascular therapy," explains Edda Tschernko, Head of the Clinical Division of Cardio Thoracic Vascular Anesthesia and Intensive Care Medicine at MedUni Vienna and University Hospital Vienna, "the management of a rare acute rejection is very demanding for the intensive care unit team. Success here depends on the earliest possible diagnosis and rapid action. We are talking about minutes until the right therapy is initiated to prevent catastrophic circulatory collapse in acute rejection." With regard to post-operative psychological stress in connection with the "acceptance" of the new heart, patients are already given psychological support in the intensive care unit. "The great expertise, empathy and willingness to talk on the part of the doctors and nursing staff make a decisive contribution to recovery," explains Tschernko. The close cooperation between cardiac surgery and intensive care medicine has led to an increase in the survival rate from 75 percent in the early years to 91 percent today.

Immunosuppression and lifelong aftercare
After transplantation, all patients require immunosuppression in order to suppress rejection reactions of the foreign organ. As a center of innovation, MedUni Vienna also plays a leading role in this area. This is evidenced by many prospective randomized multicenter studies, the results of which have influenced treatment worldwide. The current standard is individualized therapy based on the personal risk of rejection and side effects. The therapy is adjusted with the help of biomarkers. Rejections occur far less frequently today: A rejection rate of around 50 percent in the 1980s compares with 10 to 12 percent today.

The cardiac surgery outpatient clinic at University Hospital Vienna records around 3,000 patient contacts per year, over 500 of which are in follow-up care. Around 85 percent of people with a donor heart now live longer than five years, 75 percent even longer than ten years after the transplant. Walter Weiss, who was only the fifth patient in Vienna to receive a new organ in 1985, has already been living with a donor heart for 39 years. "A new life began for me back then," he explains. I returned from the brink of death to an almost normal life with full capacity." In return, Weiss is happy to visit the University Hospital Vienna outpatient clinic every few months for check-ups.