Although heart transplantation has seen much success over the last few years, there are still some areas that are challenging.  Coronary artery vasculopathy is a leading cause of death following heart transplant recipients and it believed to be due to a culmination of both immunological and nonimmunological factors.  Using gene micro arrays and natriuretic peptides, we have uncovered platelets as an important and often neglected entity in heart transplant recipients.  Investigating the effect of platelet function and alteration of their activation in this special population on transplant coronary artery disease will be focus of future research.

Antibody-mediated rejection has been identified as a risk for the development early graft failure and transplant coronary artery disease.  Several reports consistently state females, especially multiparous females as a risk for the development of antibody-mediated rejection. The exact reason for the development of antibodies in this population is not fully understood.  There is some literature investigating the importance of HLA of the spouse of multiparous females and the organ donor in renal transplant rejection and graft survival.  Determining the interaction of donor and female recipient’s spouses HLA on graft survival and pattern of rejection in heart transplantation will help determine if we need to declare the spouse’s HLA as unacceptable antigens at the time of listing.

Neurohormonal blockade and newer devices have improved the survival of heart failure patients.  However, there is much room for enhancement.  The effect of heart failure education on survival has not been suitably investigated.  Using standardized education with a core message and a testing tool to determine the adequacy of the teaching will be used to ascertain the importance of education in heart failure on outcomes including hospitalization.