Anaesthesia for a patient with a cardiac transplant

74 Cardiac transplantation has evolved over the last three decades from a procedure with a 1year survival of 20% to an established treatment for end-stage heart failure. Between 1991 and 2000, there were 2922 heart transplants performed in the UK. Oneand 10-year survivals are currently 90% and 50%, respectively, and 50% of recipients are aged 50 yr or over at the time of transplantation. Cardiac transplant recipients have an increased requirement for non-cardiac surgery; a quarter of patients undergo surgery within 2 years of transplantation. The anaesthetist may encounter such patients on both elective and emergency theatre lists. In addition, heart transplant patients may suffer medical or surgical complications that necessitate admission to the intensive care unit. Effective anaesthetic care is dependent on knowledge of the complications that occur in these patients, an appreciation of the side-effects of their immunosuppressive therapy and a clear understanding of the changes in physiology and pharmacology that cardiac transplantation produces.