Heart transplantation contraindications: Difference between revisions
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===Absolute 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 <2 y despite HT, including | ||
**Active or recent solid organ or blood malignancy within 5 y (eg. leukemia, low-grade neoplasms of the prostate with persistently elevated prostate-specific antigen) | |||
**AIDS with frequent opportunistic infections | |||
**Systemic lupus erythematosus, sarcoid, or amyloidosis that has multisystem involvement and is still active | |||
**Irreversible renal or hepatic dysfunction in patients considered for only HT | |||
**Significant obstructive pulmonary disease (Fev1 <1 L/min) | |||
*Fixed pulmonary hypertension | |||
**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=== | ===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> | <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> | ||
Revision as of 10:34, 7 June 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]
Contraindications
Absolute Contraindications
- Systemic illness with a life expectancy <2 y despite HT, including
- Active or recent solid organ or blood malignancy within 5 y (eg. leukemia, low-grade neoplasms of the prostate with persistently elevated prostate-specific antigen)
- AIDS with frequent opportunistic infections
- Systemic lupus erythematosus, sarcoid, or amyloidosis that has multisystem involvement and is still active
- Irreversible renal or hepatic dysfunction in patients considered for only HT
- Significant obstructive pulmonary disease (Fev1 <1 L/min)
- Fixed pulmonary hypertension
- 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- ILack 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.