“Our program has focused on reaching out to the Bay Area and beyond to provide advanced heart failure care closer to where our patients live and work,” says Jeffrey Teuteberg, MD, section chief of Heart Failure, Cardiac Transplantation, and Mechanical Circulatory Support. “These efforts in conjunction with the growth in our faculty and a concerted effort to innovate and improve have resulted in our consistent status as a national leader in heart transplantation.”

Innovation as a foundation for transplant success 

Stanford Health Care’s Heart Transplant Program continues to drive both research and its translation into leading-edge transplant techniques that save lives.

The first successful transplant of a beating donor heart  

An alternative pathway to expanding the availability of donor hearts involves their acquisition following cardiac death. In these cases, the hearts have ceased beating at least twice prior to transplantation, including once in the donor and a second time during transfer from a perfusion machine to the recipient. The lack of circulating oxygenated blood, even temporarily, can result in adverse outcomes for transplant recipients.

A team of cardiothoracic surgeons led by Joseph Woo, MD, chair of the Cardiothoracic Surgery Department, has successfully transplanted beating hearts into six recipients, including pediatric patients. This represents the first demonstration of a novel approach to improve the stability of a transplanted heart. Limiting the periods of time that the donor heart stops beating increases the likelihood of its acceptance and transplant success.

Noninvasive methods to evaluate and sustain transplant health

The heart transplant program has begun using simple blood tests as a replacement for traditional biopsies of a transplanted heart. Assessing cell-free DNA (cfDNA) within the circulation offers insight into rejection or other sources of injury.

Notably, cfDNA is not only noninvasive but may also be a more sensitive marker of the status of a transplanted heart. Traditional biopsies only provide data from the small area of the heart where it is safe to obtain tissue, significantly limiting their ability to provide an accurate status of the entire transplanted heart. Because cfDNA can originate from any part of the heart and be detected in blood, it offers a more holistic view of the transplant. 

Moreover, cfDNA can also play a role in tailoring immunosuppression for transplant recipients. Suppressing the immune response to foreign tissue represents a critical step in the transplant process. In this context, immunosuppression can prevent graft failure; however, determining the appropriate level of suppression is patient-specific and necessary to avoid adverse systemic side effects. Employing cfDNA provides an accurate assessment of patient and graft responses to therapy, thereby enabling a level of precision medicine for each transplant recipient.

Maximizing efforts to deliver donor hearts

Reducing transplant wait times requires addressing issues involving organ procurement. Utilizing specialized equipment that sustains donor hearts during transport over long distances has altered the landscape of organ availability.

Transporting these organs frequently involves using a heart perfusion system similar to that employed for the first beating-heart transplant. By sustaining circulation of oxygenated blood and nutrients in donor hearts, this technique can help increase the donor pool, shorten wait times, and promote better transplant outcomes.

Dedicated to saving lives

In addition to the Heart Transplant Program, Stanford Health Care offers an Advanced Heart Failure Program that provides patients options to address a wide range of issues related to heart failure. Specialists in this program are extensively trained in diagnosing different types of heart failure and providing personalized treatment options. Heart failure clinics staffed by our specialists are available at multiple locations, including Oakland, Pleasanton, San Jose, and Stanford.

“We are dedicated to providing the best care possible for our patients by utilizing our interdisciplinary team to comprehensively assess options, including medical therapies, devices, surgeries, and transplantation,” explains Teuteberg.

Stanford Health Care also provides a mobile application that allows physicians to connect with Stanford Medicine cardiovascular specialists or make referrals. The CVH Flare app offers a directory of Stanford Medicine cardiovascular specialists and multiple ways to contact them.

Learn more about Stanford Health Care’s Heart Transplant Program and the Advanced Heart Failure Program. Download the Stanford CVH Flare app to connect with cardiovascular specialists or refer patients.  

Top image of William Hiesinger, MD (left) and Patpilai Kasinpila, MD (right) aligning a donor heart immediately before placing it into a recipient’s chest during a heart transplant.
All photos courtesy of Winston L. Trope.