Improving heart transplantation care

In this dissertation we investigate ways to improve the care for heart transplantation patients. First, we investigate the waiting list mortality and the potential of Donation after Circulatory Death (DCD) heart transplantation or ‘heart in a box’. We found that the waitlist mortality is high, but DCD heart transplantations have a great potential in the Netherlands. Secondly, the incidence and treatment of certain diseases that can occur after heart transplantation are investigated. For example, kidney failure seems to be prevalent, which is best treated with a kidney transplantation. Moreover we found an association between kidney function before transplant and cancer after transplantation. Also the results of the Dutch paediatric heart transplantation programme is evaluated demonstrating good results with excellent quality of life. In the last part we investigate the use of CT scans in heart transplantation recipients. According to the guidelines, the coronary arteries of these patients should be evaluated every year (since these patients normally don’t feel chest pain, and coronary artery disease (called CAV in heart transplant patients) is prevalent), preferably with coronary angiography. However, this is an invasive method with risks. So we investigated whether or not CT scans are a good alternative, which was confirmed in our studies. Further investigations correlated a fat layer around the heart to CAV and investigated the incidence of reduced bone density and liver fat using the CT scan.