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Professor Sir Magdi Yacoub, FRS Imperial College London Heart Science Centre

Madrid2009. CARDIC REPLACEMENT FOR ESHD need,supply,dreams. Professor Sir Magdi Yacoub, FRS Imperial College London Heart Science Centre. Long term outcome after Heart Transplantation. Chronology Historical perspective -need/supply Definitions “Long term”-Dreams’ Results

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Professor Sir Magdi Yacoub, FRS Imperial College London Heart Science Centre

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  1. Madrid2009 CARDIC REPLACEMENT FOR ESHD need,supply,dreams Professor Sir Magdi Yacoub, FRS Imperial College London Heart Science Centre

  2. Long term outcome after Heart Transplantation • Chronology • Historical perspective -need/supply • Definitions “Long term”-Dreams’ • Results • The end of the beginning • The future

  3. Long term outcome after Heart Transplantation • Historical perspectives • 60 years ago: fantasy for the future • 40 years ago: clinical introduction • Enthusiastic reception • Moratorium • c) Steady progress-massive neeed. • results (longtherm)

  4. Long term outcome after Heart Transplantation • Definitions • Long term (DREAMS) • Expectations – moving target • 5 year survival (cancer model) • 10-15-20 years • - Age matched normal population

  5. Long term outcome after Heart Transplantation • Results • ISHLT 2007 • Transplant “half-life” = 10 years for adult And paediatric recipients • Conditional half-life for those who survive 1 year = 13 years • Constant attrition of survival 3.4% per year

  6. Long term outcome after Heart Transplantation Long Term Results Twenty year survival Stanford 12.5% 1968-1987 Harefield 25% 1980-1985 Fifteen year survival Different series 20-33%

  7. Long term outcome after Heart Transplantation • The end of the beginning • With maturity comes responsibility • Why only less than 12.5-25% survive 20 years • No match to general population • Constant hazard function of death of 3.4% year

  8. Long term outcome after Heart Transplantation • Causes of attrition in survival and quality of life • Graft coronary disease • Malignancy 10-100 fold • Renal dysfunction • Infection

  9. Long term outcome after Heart Transplantation • The Future • Personalized medicine • (Taegtmeyer, Barton, Yacoub, Nature 2006) • 2. Improving donor quality and availability (perfusion devices) • 3. Early detection and treatment of rejection, cancer, renal dysfunction • 4. Newer immunosuppression • 5. The Holy Grail • - Specific Immune Tolerance

  10. The Quest for Medawar’s Tolerance Issues Who is Medawar? What is the Quest for Tolerance? What have we done about it? What does the future hold?

  11. The Quest for Medawar’s Tolerance

  12. The Quest for Medawar’s Tolerance Isn’t he beautiful?

  13. The Quest for Medawar’s Tolerance Peter Medawar - 1915-1987 1) Scientist “A tireless searcher for the truth, merciless debunker of myths” 2) “Father” of organ transplantation 3) A philosopher 4) A “humanist”

  14. The Quest for Medawar’s Tolerance The Threat and the Glory “It is the great glory as it is the great threat of science that everything which is in principle possible can be done if the intention to do it is sufficiently resolute.” Peter Medawar

  15. The Quest for Medawar’s Tolerance The Future - Induction of Medawar’s Tolerance is badly needed to rejuvinate tissue and organ transplantation - The question is how resolute is our clinical and research community?

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