Heart transplantation contraindications: Difference between revisions
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{{Heart transplantation}} | {{Heart transplantation}} | ||
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}} | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}{{IF}} | ||
=Overview= | |||
Contraindications to cardiac transplantation include any [[Multisystem organ failure|multisystem]]/systemic or life-shortening disease with a life expectancy of less than years, despite a [[heart transplant]]. Other factors that may be potential contraindications to be considered are- [[Ageing|age]], [[obesity]], [[cancer]], [[diabetes]], [[Renal insufficiency|renal dysfunction]], [[peripheral vascular disease]], [[Infection|infections]], and [[Substance abuse|substance abuse.]] | |||
==Contraindications== | ==Contraindications== | ||
=== | ===Absolute Contraindications=== | ||
* | <ref name="ManciniLietz2010">{{cite journal|last1=Mancini|first1=Donna|last2=Lietz|first2=Katherine|title=Selection of Cardiac Transplantation Candidates in 2010|journal=Circulation|volume=122|issue=2|year=2010|pages=173–183|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.109.858076}}</ref> | ||
*Systemic illness with a [[life expectancy]] of less than 2 years ''despite'' HT, including | |||
**Active or recent solid organ or blood [[malignancy]] in the last 5 years | |||
**[[HIV AIDS|AIDS]] complicated by frequent [[opportunistic infection]]<nowiki/>s | |||
**Active diseases with [[Multisystem organ failure|multisystem]] involvement like- [[systemic lupus erythematosus]], [[sarcoidosis]], or [[amyloidosis]] | |||
**Irreversible [[renal]] or [[Hepatic failure|hepatic dysfunction]] | |||
**Significant [[obstructive pulmonary disease]] | |||
*Fixed or irreversible [[pulmonary hypertension]] defined by the following findings- | |||
**Pulmonary artery systolic pressure >60 mm Hg | |||
**Mean transpulmonary gradient >15 mm Hg | |||
**[[Pulmonary vascular resistance]] >6 Wood units | |||
=== | ===Relative Contraindications due to associated [[comorbidities]]=== | ||
<ref name="MehraCanter2016">{{cite journal|last1=Mehra|first1=Mandeep R.|last2=Canter|first2=Charles E.|last3=Hannan|first3=Margaret M.|last4=Semigran|first4=Marc J.|last5=Uber|first5=Patricia A.|last6=Baran|first6=David A.|last7=Danziger-Isakov|first7=Lara|last8=Kirklin|first8=James K.|last9=Kirk|first9=Richard|last10=Kushwaha|first10=Sudhir S.|last11=Lund|first11=Lars H.|last12=Potena|first12=Luciano|last13=Ross|first13=Heather J.|last14=Taylor|first14=David O.|last15=Verschuuren|first15=Erik A.M.|last16=Zuckermann|first16=Andreas|title=The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update|journal=The Journal of Heart and Lung Transplantation|volume=35|issue=1|year=2016|pages=1–23|issn=10532498|doi=10.1016/j.healun.2015.10.023}}</ref> | |||
*'''[[Age]]''' - Patients are considered for cardiac transplant if they are < 70 years of age; or carefully selected patients over age 70. | |||
* '''[[Obesity]]'''- [[Body mass index|BMI]] > 35 kg/m 2 is associated with a worse outcome. | |||
* '''[[Cancer]]'''- Careful assessment of each [[neoplasm]] with a collaboration with oncology specialists to stratify each patient must be done. <ref name="pmid19195521">{{cite journal| author=Kellerman L, Neugut A, Burke B, Mancini D| title=Comparison of the incidence of de novo solid malignancies after heart transplantation to that in the general population. | journal=Am J Cardiol | year= 2009 | volume= 103 | issue= 4 | pages= 562-6 | pmid=19195521 | doi=10.1016/j.amjcard.2008.10.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195521 }} </ref> | |||
* '''[[Diabetes]]'''- End-organ damage and persistent poor [[Glycemic Targets in Diabetes|glycemic]] control ([[glycosylated hemoglobin]] [<nowiki/>[[Glycosylated hemoglobin|HbA 1c]]] > 7.5% or 58 mmol/mol) are relative contraindications | |||
* '''[[Renal insufficiency|Renal dysfunction]]'''- Irreversible [[renal dysfunction]] ( [[eGFR]] < 30 ml/min/1.73 m 2) is a relative contraindication | |||
* '''[[Peripheral vascular disease]]'''- Clinically severe symptomatic [[cerebrovascular disease]] may be considered a contraindication. | |||
* '''[[Infection|Infections]]'''- Use of [[Immunosuppressive therapy|immunosuppressive]] therapy post-transplantation may cause a flare up of active [[Infection|infections]]. | |||
**[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency viral (HIV) infection]] | |||
**[[Chagas disease]] | |||
**[[Tuberculosis]] | |||
**[[Hepatitis B]] and [[Hepatitis C|C]] viral (HBV and HCV) infections | |||
* '''[[Tobacco Use Disorder|Tobacco]] use'''- Active tobacco smoking is a relative contraindication. | |||
*[[Substance abuse|'''Substance Abuse'''-]] Active substance abusers (including [[Alcohol, Drug Abuse, and Mental Health Services Block Grant|alcohol]]) cannot receive a heart transplant. | |||
* '''[[Psychosocial|Psychosocial evaluation]]'''- Lack of social support of presence of [[Cognitive|cognitive disability]] are relative contraindications. | |||
==References== | ==References== | ||
Latest revision as of 00:44, 10 July 2020
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]
Overview
Contraindications to cardiac transplantation include any multisystem/systemic or life-shortening disease with a life expectancy of less than years, despite a heart transplant. Other factors that may be potential contraindications to be considered are- age, obesity, cancer, diabetes, renal dysfunction, peripheral vascular disease, infections, and substance abuse.
Contraindications
Absolute Contraindications
- Systemic illness with a life expectancy of less than 2 years despite HT, including
- Active or recent solid organ or blood malignancy in the last 5 years
- AIDS complicated by frequent opportunistic infections
- Active diseases with multisystem involvement like- systemic lupus erythematosus, sarcoidosis, or amyloidosis
- Irreversible renal or hepatic dysfunction
- Significant obstructive pulmonary disease
- Fixed or irreversible pulmonary hypertension defined by the following findings-
- Pulmonary artery systolic pressure >60 mm Hg
- Mean transpulmonary gradient >15 mm Hg
- Pulmonary vascular resistance >6 Wood units
Relative Contraindications due to associated comorbidities
- Age - Patients are considered for cardiac transplant if they are < 70 years of age; or carefully selected patients over age 70.
- Obesity- BMI > 35 kg/m 2 is associated with a worse outcome.
- Cancer- Careful assessment of each neoplasm with a collaboration with oncology specialists to stratify each patient must be done. [3]
- Diabetes- End-organ damage and persistent poor glycemic control (glycosylated hemoglobin [HbA 1c] > 7.5% or 58 mmol/mol) are relative contraindications
- Renal dysfunction- Irreversible renal dysfunction ( eGFR < 30 ml/min/1.73 m 2) is a relative contraindication
- Peripheral vascular disease- Clinically severe symptomatic cerebrovascular disease may be considered a contraindication.
- Infections- Use of immunosuppressive therapy post-transplantation may cause a flare up of active infections.
- Human immunodeficiency viral (HIV) infection
- Chagas disease
- Tuberculosis
- Hepatitis B and C viral (HBV and HCV) infections
- Tobacco use- Active tobacco smoking is a relative contraindication.
- Substance Abuse- Active substance abusers (including alcohol) cannot receive a heart transplant.
- Psychosocial evaluation- Lack of social support of presence of cognitive disability are relative contraindications.
References
- ↑ Mancini, Donna; Lietz, Katherine (2010). "Selection of Cardiac Transplantation Candidates in 2010". Circulation. 122 (2): 173–183. doi:10.1161/CIRCULATIONAHA.109.858076. ISSN 0009-7322.
- ↑ Mehra, Mandeep R.; Canter, Charles E.; Hannan, Margaret M.; Semigran, Marc J.; Uber, Patricia A.; Baran, David A.; Danziger-Isakov, Lara; Kirklin, James K.; Kirk, Richard; Kushwaha, Sudhir S.; Lund, Lars H.; Potena, Luciano; Ross, Heather J.; Taylor, David O.; Verschuuren, Erik A.M.; Zuckermann, Andreas (2016). "The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update". The Journal of Heart and Lung Transplantation. 35 (1): 1–23. doi:10.1016/j.healun.2015.10.023. ISSN 1053-2498.
- ↑ Kellerman L, Neugut A, Burke B, Mancini D (2009). "Comparison of the incidence of de novo solid malignancies after heart transplantation to that in the general population". Am J Cardiol. 103 (4): 562–6. doi:10.1016/j.amjcard.2008.10.026. PMID 19195521.