Les débuts de la transplantation cardiaque en Belgique ou la conjonction de patients déterminés, cardiologues confiants et chirurgien prêt à aller de l'avant

The first heart transplantation (HTx) in Belgium was performed by us at university hospital Brugmann on August 23, 1973. At this time, organ procurement was still a sensitive procedure not regulated as well as it is nowadays. Among other difficulties, diagnosis of rejection after the operation was only based upon clinical signs and electrocardiographic voltage variations. Echocardiography did not exist yet and endocardiac biopsy was unknown. Moreover the variety of immunosuppressive drugs was scarce and their potency far from what we are used to in the present era. Three patients were transplanted with excellent immediate survival but nevertheless the first died after six months from an acute broncho-pulmonary infection ;the second after one year of an ongoing chronic rejection and the third after two weeks of an acute rejection. Deeply frustrated by these unrewarding results alltogether for the patients and the doctors, it was decided to stop the programme until new progress would allow early and objective diagnosis of rejection and provide access to more potent immunosuppressive drugs. This became a reality in 1981 with the release of ciclosporine and the introduction in clinical practice of transvenous endocardiac biopsy to diagnose rejection and to monitor the outcome of its treatment further on. Those two opportunities were a major breaktrough for HTx which knew a spectacular revival worldwide. Ciclosporine arrived in Belgium in 1982 and we soon restarted HTx at Erasme Hospital. Comparing our results of HTx in the pre-ciclosporine period with the ones in the current era is striking. The cumulative 25 years experience of HTx at Erasme is briefly alluded to. We also remind that the first heart-lung transplantation (HLTx) in Belgium was performed by us in august 1983 at Erasme hospital credited to be the third center in Europe having successfully initiated this therapy for terminal heart-lung failure.SCOPUS: re.j