LA HISTORIA DEL TRASPLANTE CARDIACO EMPEZO HACE 50 AÑOS




La historia del trasplante cardiaco comenzó hace 50 años: el doctor Barnard se adelantó a todos en una 'competición' que ha salvado miles de vidas en todo el mundo

ISABEL IBÁÑEZ y JOSEMI BENÍTEZ
Cuando Juan Francisco Delgado despertó de la operación, preguntó a los cirujanos en qué estado habían encontrado el corazón que acababan de extirparle. «Hubiera durado seis meses», dijeron. De eso hace 32 años. Es el segundo trasplantado cardiaco más longevo de España –el primero, un año más, no se encuentra bien de salud–. Uno de los pioneros de la lista que engrosan 8.000 personas en nuestro país (427 niños). Hoy se cumplen 50 años desde que el doctor sudafricano Christiaan Barnard diera el pistoletazo de salida al recolocar en el pecho de Louis Washkansky, un comerciante de ultramarinos de 56 años, el corazón de Denise Darvall, una oficinista de 25 que murió atropellada. Sobrevivió 18 días y el mundo se volvió loco.
Delgado tenía 7 años cuando la noticia copó los periódicos, sin saber que le afectaría tan de cerca. A los 14 le detectaron una cardiomiopatía que no le dejaba hacer «nada» y estuvo una década entrando y saliendo de urgencias hasta que le hablaron de trasplante. «No habían evolucionado mucho con el rechazo, pero no quedaba otra. ¿Miedo? Yo estaba muy fastidiado, pensaba que se podían equivocar, pero me decía que cuándo podría tener otra oportunidad y... Tuve que arriesgar, tirar pa’lante y punto pelota. Un día llamaron para decirme que tenían un corazón, pero había otro enfermo compatible que estaba peor, así que se lo pusieron a él, y yo esperé dos meses más. El primer año casi no salí del hospital por los rechazos, pero aquí estoy». Trabaja de conserje, cuida la alimentación y toma sus medicamentos. Conoce la identidad de su donante por casualidad, aunque por ley son anónimos; sólo se informa de peso y talla, causa de la muerte y, en algún caso, edad y sexo. Pero la curiosidad y las esquelas suelen aliarse.
Poco después que Barnard, en 1968, el doctor Cristóbal Martínez Bordiú, el 'yernísimo' de Franco, pretendió repetir la gesta en nuestro país; para muchos, un intento del régimen de marcarse un tanto. Pero su paciente, un fontanero gallego, murió a las pocas horas y la hazaña quedó en anécdota. Y hubo que esperar tres lustros, porque esta historia de medio siglo tiene dos fases: antes y después del hito que supuso en 1983 la aprobación de la ciclosporina, un eficaz inmunosupresor para frenar el rechazo.
Precisamente, la noche del 8 de mayo de 1984, en el Hospital Santa Creu i Sant Pau de Barcelona, el doctor José María Caralps llevaba a cabo el primer trasplante de corazón con éxito de España: Juan Alarcón, 29 años, vivió nueve meses.«Aquella tarde –recuerda Caralps (Barcelona, 1942)– se iba retrasando la extracción. Jugamos al parchís, a las cartas... Dormimos incluso un rato, así que cuando, a las cuatro o cinco horas, nos avisaron de que llegaba el órgano, ya había gastado toda la adrenalina. Lo hicimos como estaba planeado y al ver que funcionaba nos pusimos muy contentos. Yo había interiorizado la operación millones de veces». No tuvo el reconocimiento esperado: «Ni un equipo de cirugía nos llamó para felicitarnos. A la gente le sentó mal que nos atreviéramos a hacer algo a lo que nadie se atrevía», dice el cirujano. Sus manos han recolocado 200 corazones.
Barnard también afrontó críticas. Caralps estaba en el Hospital Maimonides de Nueva York haciendo tres trasplantes diarios en perros cuando llegó la noticia. «Fue una conmoción porque, en el mismo Maimonides, había mucha gente que se estaba preparando para ello. Recuerdo haberme abrazado a un colega japonés porque se confirmaba que lo que hacíamos era viable en humanos y salvaría miles de vidas». Pero muchos consideraron que Barnard no era el más preparado; en EE UU estaba Norman Shumway, del que había aprendido la técnica y que estaba esperando a solucionar el problema del rechazo. «Dijeron que tenía que haber sido él, que a ver qué se creía Barnard. Sudáfrica estaba inmersa además en el 'apartheid' y cuando vino a dar una charla ningún médico negro asistió al cóctel».

Con Grace de Mónaco

Para colmo, se convirtió casi en una 'estrella' de Hollywood; lo mismo aparecía conduciendo un descapotable que bailando con la princesa Grace de Mónaco. Lo recuerda Lorenzo Silva, jefe de la sección de Cuidados Agudos Cardiológicos del Puerta de Hierro, el hospital con el récord de trasplantes de corazón en España, unos 900. Tenía 9 años cuando Barnard hizo historia: «Mi padre era médico rural y vimos la noticia. También me acuerdo de la artrosis de sus manos, de su mujer, de que se volvió a casar...». El cardiólogo estuvo en aquellos primeros trasplantes. «En el 84, a una niña de 11 años que se ha vuelto a retrasplantar. Fue muy emocionante entrar al quirófano con el doctor Figueras y el doctor Alonso-Pulpón, uno de los responsables de que el trasplante cardiológico en España ocupe el lugar que ocupa».
Silva destaca cómo la terapia del rechazo «ha mejorado mucho; la calidad de vida es muy buena. La mortalidad hospitalaria es de un 13%, pero la supervivencia alcanza el 80% el primer año y el 70% a los cinco. A los once, la mitad siguen vivos». Aunque a veces las cosas se tuercen; su mente guarda un lugar para un joven con una cardiopatía congénita: «Parecía un niño. Recuerdo cómo llamaba a su madre cuando apareció un donante. ‘¡Mamá, mamá!’, decía aterrado. Y se nos murió en la mesa de operaciones. Lo pasé muy, muy mal».

En cifras

7.023
trasplantes de corazón se hicieron en todo el mundo en 2016 (de un total de 126.670, según datos del Registro Mundial de trasplantes). En nuestro país se realizaron 4.818 trasplantes, de los que 281 fueron cardiacos.
Líderes mundiales
España es líder mundial en pacientes trasplantados por millón de población, con 102,3, muy por encima de la media de la Unión Europea (64) y superior a Estados Unidos (99,9).
Hasta cien personas
están implicadas en un trasplante de corazón: cirujanos, cardiólogos, anestesistas, enfermeros, personal de laboratorio y de la UCI, inmunólogos haciendo estudios de compatibilidad de órganos...
También ha afrontado momentos así Juan Miguel Gil-Jaurena, jefe de cirugía cardiaca infantil del Gregorio Marañón. Incluso sufrió un 'escrache' de unos padres que perdieron a su hijo adolescente. «No quiero ni hablar de ello. Te lamentas, te preguntas si en vez de a ese deberías habérselo puesto a otro, pero entrarías en un bucle de autorreproches insano. Lo hacemos lo mejor que podemos». Y la mayoría de las veces son alegrías: opera a unos diez niños al año (menores de 18 y adultos con cardiopatías congénitas), que representan el 10% de los trasplantes de corazón en España. Y su supervivencia está en el 85-90%.
Un niño necesita un corazón algo más grande que el suyo. Y como afortunadamente hay pocos donantes, tienen que aceptar «discrepancias de tamaño». «No te asustes –cuenta Gil-Jaurena–, pero hace dos años tuvimos un donante de diez kilos y un receptor de tres; hubo que dejarle varios días con el tórax abierto hasta que se fue acomodando. Hoy está hecho un pimpollo. Tenemos la suerte de que cuanto más pequeño es el paciente mejor se adapta». Con niños es difícil contabilizar la lista de espera. Una vez incluyeron a uno de dos meses y esa misma noche llegó un corazón. Por contra, una cría de 3 años esperó seis meses con uno artificial. ¿Sigue emocionándose con su trabajo? «Ese momento en el quirófano en el que ves que el corazón vuelve a latir es, es... magia».

12 comentarios:

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17 de mayo de 2019, 10:17 comment-delete

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6 de julio de 2019, 4:07 comment-delete

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27 de julio de 2019, 12:44 comment-delete

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