Multiorgan Transplantation: Heart-Lung

On 9 March 1981, Drs. Reitz, Shumway, and Wallwork made history by performing the first heart-lung transplant (HLTx) at Stanford Medical Center on 45-year-old Mary Gohlke, who was in the end stages of her primary pulmonary hypertension. HLTx indications have evolved remarkably during the past decades and the number of transplants worldwide has declined. The current heart and lung bloc donor evaluation is very similar to the one described by Jamieson and colleagues at Stanford back in the 1980s. UNOS changed the heart allocation policy in the USA in October 2018. Immunosuppressive strategies have evolved significantly since the first successful HLTx. In HLTx, the simultaneous rejection of both heart and lung is rare, and the endomyocardial biopsy does not help diagnose acute lung rejection. Early postoperative complications are usually related to postperfusion syndrome, or pulmonary or cardiac allograft dysfunction, as is seen in isolated lung transplant or HTx recipients.