How do you keep a heart-transplant recipient alive and healthy for the long term?
That was the challenge taking shape by the mid-1970s, when Sharon Hunt, MD, was a cardiology fellow at Stanford Hospital. Meeting the challenge has since defined her career and earned her one of the most prestigious awards in the field of heart-transplantation medicine: the International Society for Heart and Lung Transplantation award for lifetime achievement, which she accepted in April in Prague.
"It's the biggest honor I've ever had," Hunt said.
Hunt arrived at Stanford as a first-year medical student in the fall of 1967. A few months later, Stanford cardiac surgeon Norman Shumway, MD, and his team performed the first adult human heart transplantation in the United States. The success of that feat (the patient survived 14 days) inspired other surgeons across the nation to try their hand at the operation. However, most recipients survived just a few weeks or months, and an unofficial moratorium on the procedure went into effect in 1970. Over the next decade, Shumway's team, which ignored the moratorium, made steady progress in refining its surgical techniques, introducing the heart biopsy for assessment of acute organ rejection and determining the viability of hearts procured and then transported to a transplant center. By 1974, 40 percent of their patients were living for two years, and 26 percent were making it to three years.
"By the time I was finishing cardiology training, in 1977, the survival rates for transplant patients were getting to be substantial," said Hunt, a cardiologist at Stanford Hospital & Clinics and professor of cardiovascular medicine at the School of Medicine. "The surgeons had always claimed care of these patients, but with longer survival rates they were getting opportunistic infections and other medical problems – things the surgeons didn't want to deal with. So they started looking to cardiology trainees to supply medical care. Like lots of people in advanced medical training, I was looking for a niche, and this one looked promising."
Hunt remained at Stanford after her fellowship, forging a path in this burgeoning field. Her efforts earned her a clinical assistant professorship in 1981. Since then, key advances in long-term postoperative care for heart recipients have stemmed largely from her research and clinical work.
"Even after the surgical technique for heart transplantation had been developed and operations had been done, the field was naïve in that people didn't know how to manage patients," said cardiologist Michael Pham, MD, MPH, a clinical associate professor of medicine at Stanford. "How do you manage patients who will be on immunosuppressive medications for the rest of their lives? How do you balance the benefit of these drugs with their toxicities in the long run? How do you identify and treat patients who reject their transplanted hearts? These are some of the questions that Sharon has done more than anyone to answer."
Indeed, heart-transplant patients face a host of diseases and complications that can set back or snuff out their delicate new lease on life. These are diseases such as cardiac allograft vasculopathy, in which the walls of the coronary arteries become thicker, obstructing blood flow; infection, cancer and kidney failure, all abetted by the powerful immunosuppressant that recipients take to prevent rejection; and many others complications, including high blood pressure and high cholesterol.
"Without Sharon, who took care of these transplant patients after figuring out their medications and complications, there would be no successful cardiac transplantation at all," said Alan Yeung, MD, chief of cardiovascular medicine at Stanford Hospital and the Li Ka Shing Professor in Cardiology.
The lifetime achievement award also recognizes Hunt for having trained many international leaders in the field of post-transplant cardiology. She has made significant scientific contributions (she has authored or co-authored close to 200 peer-reviewed articles); headed the recent development of international guidelines on the care of heart-transplant recipients; and helped pave the way to the certification of the subspecialty in advanced heart failure and transplant cardiology by the American Board of Internal Medicine.
The International Society for Heart and Lung Transplantation has given only five lifetime achievement awards in its 31-year history. Two have gone to Hunt's late Stanford colleagues and mentors, Shumway and Margaret Billingham, MD, a renowned cardiac pathologist. The others went to Sir Magdi Yacoub, MD, an Egyptian-born cardiothoracic surgeon, and the late Keith Reemtsma, MD, a pioneering transplant surgeon.
Among dozens of other accomplishments, Hunt has also served as chair of the American College of Cardiology/American Heart Association Guidelines Committee to Rewrite Heart Failure Guidelines, which Pham called "probably the most commonly quoted guidelines ever in the field of cardiovascular medicine," and as associate editor of the textbook Hurst's The Heart and the Journal of Cardiac Failure.
"Through the years, she has just been incredibly productive. Her trainees comprise the leaders and experts in the field of heart transplant cardiology around the world," said Bruce Reitz, MD, the Stanford cardiothoracic surgeon who performed the first successful heart-lung transplant. "She's also a wonderful colleague—the ideal colleague—who is very responsive, and with solutions and suggestions that are very helpful. You also know that when a patient is under her care, that patient is getting the absolute best care."
Hunt said the two things she likes most about her job are mentoring cardiology fellows and taking care of patients, "though I still don't like reading EKGs or being on-call all night."
What about her next steps?
"I think I'll keep doing what I'm doing for the next few years," she said.
By John Sanford