In 2024, UC Health will celebrate 35 years of performing heart transplants. Since completing their first heart transplant in March 1989, UCSF surgeons have performed nearly 600, and along the way, the health system has become a recognized leader in treating heart failure and the sixth largest program for transplants in the nation. In the past few years, heart transplants have increased substantially – from 17 in 2020 to nearly 80 heart transplants in 2023.
The increasing numbers of transplants are a result of a commitment by UCSF Health to become one of the pre-eminent health systems for advanced heart failure and heart transplant. UCSF’s Advanced Heart Failure Comprehensive Care Center (AHF CCC) was established in 2021 to provide a continuum of patient care under one umbrella program. The center specializes in heart failure disease management, implantable heart failure device therapies, surgical heart failure therapies, mechanical circulatory support, heart transplantation, and innovative clinical research trials for patients who are not responding to traditional therapies. The AHF CCC has a dedicated, multidisciplinary team of over 40 healthcare professionals caring for patients across the spectrum of advanced heart failure.
AHF CCC is using new technologies that make it possible to increase the number of hearts available for transplantation. The center accepts heart transplant donors that were previously not qualified, by using innovative organ preservation technologies such as the Paragonix SherpaPak and the TransMedics Organ Care System.
In 2022, UCSF cardiovascular surgeons began performing transplants from donors after circulatory death (DCD), a procedure performed by only about 20 health systems in the U.S. Traditionally, heart donations depend on a determination of brain death. Donation after circulatory death occurs after the heart has stopped beating and there is a determination of cardiopulmonary death. UCSF now uses DCD donors to expand the pool of donor hearts.
“DCD transplantation has impacted the number of heart transplants available to patients with advanced heart failure more profoundly than any other intervention within the last 30 years,” said Jason Smith, MD, FACS, a UCSF Professor of Clinical Surgery as well as Surgical Director of Heart Transplant and Mechanical Circulatory Support. “We are glad to be able to offer this therapy to our patients at UCSF.”
Expanding the Donor Heart Pool
The center’s ex-vivo organ perfusion program uses the TransMedics Organ Care System, which pumps hearts with donor blood, perfusing the coronary arteries as the heart is transported to UCSF from a donor hospital. This has enabled the donation of organs from across the U.S. – as far away as Florida, Pennsylvania, Rhode Island and Alaska.
The heart transplant program also has an active hepatitis C donor utilization program. Heart recipients receive anti-viral medication post-transplant, with a 100% cure rate of hepatitis C and benefiting from a healthy heart. AHF CCC is also increasing number of multi-organ transplants including heart/lung, heart/liver and heart/kidney as well as complex adult congenital heart transplants.
“By increasing donor availability through utilization of donors after cardiac death and with hepatitis C, we have been decreasing waitlist times for patients awaiting a new heart,” said Liviu Klein, MD, MS, Section Chief of Advanced Heart Failure, Mechanical Circulatory Support, Pulmonary Hypertension and Heart Transplantation, and Medical Director of AHF CCC.
Advanced Heart Failure Leadership
The center has been recognized by The American Heart Association (AHA) for its leadership in cardiogenic shock treatment and its participation as the first Northern California health system in the AHA’s new Cardiogenic Shock Registry. The AHF CCC team works in close coordination with UCSF’s cardiac ICU to allow heart failure and cardiogenic shock patients from local and regional hospitals to be transferred quickly to UCSF with rapid deployment of ECMO allowing patients to recover while awaiting transplantation or left ventricular assist device (LVAD) insertion at UCSF.
AHF CCC’s Mechanical Circulatory Support program has become one of the biggest LVAD implant centers in the West. UCSF specialists almost exclusively perform bi-thoracotomy (minimally invasive) LVAD implantation which spares the sternum from more invasive surgery so patients can rehab faster and recover quickly. The AHF CCC anticipates the initiation of a total artificial heart (TAH) program in spring of 2024.
Heart failure and LVAD patients also benefit from the highest level of care with advanced artificial intelligence software enhancements which are used to integrate remote heart monitoring from home. UCSF is the national lead institution in an ongoing clinical trial for this technology. Offering remote monitoring strategies improves patient monitoring and allows earlier intervention to keep patients out of the hospital.