Heart transplants have always been problematic, mainly due to the absence of a totally reliable immunosuppressive drug to deal with the rejection problem.
Everything changed in the middle of the 20th century, when a man collected some soil samples during his holidays in Norway, which would allow him to achieve success rates of 80% from now on .
Overcoming azathioprine
Until 1969, azathioprine was used in heart transplants, which worked, but not as often as would be desirable. But it was that year that an employee of the Swiss pharmaceutical company Sandoz named HP Frey who was on vacation in Norway collected soil samples and transported them to the company’s laboratories.
It was not Frey’s whim, as Sandoz had already instructed his employees to bring soil samples during their travels in order to find an interesting antibiotic. As Bill Bryson explains in his book The Human Body :
Frey’s sample contained a fungus, Tolupocladium inftatum, which had no useful antibiotic properties, but proved to be an excellent suppressant of the immune response, just what it needed to make organ transplants possible. Sandoz converted Frey’s sachet of soil, and a similar sample that was later found in Wisconsin, into a drug that would be a real best-seller called cyclosporine.
In addition to transplant medicine, cyclosporine is also used in psoriasis and atopic dermatitis and infrequently in rheumatoid arthritis and related diseases, although only in the most severe cases. It has been investigated for use in many other autoimmune diseases. Cyclosporine has also been used as an adjunct in the treatment of ulcerative colitis that does not respond to steroidal treatment.
Currently, between 4,000 and 5,000 heart transplants are performed worldwide , with an average survival time of 15 years. The prognoses of life expectancy for heart transplant patients has increased very positively during the last 20 years, and data from August 2006, the rate of survivors are as follows :
- 1 year: 86.1% (men), 83.9% (women)
- 3 years: 78.3% (men), 74.9% (women)
- 5 years: 71.2% (men), 66.9% (women)