Comeback for Heart Transplants

A new drug dramatically increases the survival rate

Heart Surgeon Denton Cooley had just topped off 27 holes of golf with a Sunday dinner at his vacation home in Galveston, Texas, when an urgent call came through from Houston: a heart was available for transplant. Cooley raced to the Texas Heart Institute, and by 1:30 the next morning, after a 2 1/2-hour operation, a 43-year-old man from Ohio had a new heart and Cooley had completed only his third such procedure in four years.

Since that day last month, Cooley has performed another heart transplant and has made plans for 33 more over the next two years. His renewed activity is part of a nationwide comeback for heart-transplant surgery after a distressing period in which almost all its early advocates had abandoned the operation. The reason: a fatality rate of up to 80% within a year after the surgery. Patients were often given huge doses of powerful immunosuppressive drugs to keep them from rejecting the "foreign" heart tissue, but the drugs made the patients vulnerable to other diseases. Says Cardiologist Philip Oyer of Stanford University: "The vast majority of heart-transplant patients who died did so from infection."

Now, thanks to an important new drug called cyclosporine, the heart transplant may become the more nearly routine operation doctors once envisioned. Developed by the Swiss firm Sandoz Ltd., cyclosporine is a natural fungal compound that somehow blocks the production of those white cells that cause rejection but not those that fight infection. Says Dr. Barry Kahan, head of the organ-transplant division of the University of Texas Medical School at Houston and a colleague of Cooley's: "This is the secret ingredient, the thing that unlocks the door to transplants."

In experimental use in the U.S. since 1979, cyclosporine, says Sandoz, has dramatically increased survival rates for kidney transplants, from a range of 45% to 55% to a range of 80% to 90%, and for liver transplants from 30% to 70%. The first heart transplant using cyclosporine was performed in December 1980 by a Stanford University team, including Oyer and headed by Dr. Norman Shumway, who had pioneered the first heart transplant in the U.S. twelve years earlier. The team has now done 36 transplants using cyclosporine, and although Oyer cautions, "It's too early to tell," the preliminary one-year survival rate has risen from 65% in the 1970s to 79%. One of the recent successes at Stanford is Machinist William Sweet, 44, of Rochester, who had a heart transplant in April, along with cyclosporine treatment. Says Sweet: "I feel great. I'm waiting to go home."

Cyclosporine is not a panacea for transplant problems. It is expensive to make and produces some ominous side effects: it is toxic to the kidneys, and there is some evidence that it is associated with lymphatic tumors. But both conditions appear to be linked to higher dosages. Sandoz is submitting cyclosporine to the Food and Drug Administration for approval this fall.

The advent of cyclosporine, however, may aggravate some major problems already associated with heart transplants. The National Institutes of Health has estimated that 15,000 Americans need a new heart each year. But only 1,000 to 2,000 hearts are annually available for transplant. A second issue is money: a heart transplant can cost more than $100,000 and is not covered by most medical-insurance plans. Finally, cyclosporine will help make problematical procedures like heart transplants more competitive for scarce medical and financial resources.

Cooley is undeterred by the problems. "We have been waiting for something to come along and renew our interest in heart transplants," he notes. "I said twelve years ago that they were not gimmicks or stunts. Cyclosporine will lead to the rebirth of heart transplants in a really significant way."

This file is automatically generated by a robot program, so viewer discretion is required.