Heart transplantation criteria: Difference between revisions

	Heart transplantation Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Epidemiology and Demographics
Risk Factors
Screening
Complications and Prognosis
Diagnosis
Indications
Evaluation
Contraindications
Criteria for Cardiac Transplantation
Equitable Distribution of Donor Hearts to those Awaiting Transplantation and the Process of Being Listed for a Transplant
Treatment
Medical Therapy
Surgery
Follow-Up
Electrocardiogram and Pacing After Cardiac Transplantation
Heart transplantation criteria On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Heart transplantation criteria All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Heart transplantation criteria
CDC onHeart transplantation criteria
Heart transplantation criteria in the news
Blogs on Heart transplantation criteria
Directions to Hospitals Treating Heart transplantation
Risk calculators and risk factors for Heart transplantation criteria

VisualWikitext

Revision as of 11:03, 7 June 2020

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]

Criteria for Cardiac Transplantation

While assessment of the indications and contraindications are important first steps in evaluating the appropriateness for cardiac transplantation, the prognosis of a patient with and without transplantation is critical in making the final determination as to whether a patient is suitable for cardiac transplantation. Discussed below are criteria that are used based upon the estimation of the patient's prognosis. The pre-transplantation evaluation includes-

Cardiopulmonary stress testing to guide transplant listing

Exercise capacity as assessed by VO2max is a dynamic objective variable that assesses cardiac reserve and peripheral adaptations to a reduced cardiac output much more accurately than NYHA classification.

A maximal cardiopulmonary exercise test is defined as one with a respiratory exchange ratio (RER) > 1.05 and achievement of an anaerobic threshold on optimal pharmacologic therapy.

Use of Heart Failure prognosis scores

Seattle Heart Failure Model (SHFM) - An estimated 1-year survival as calculated by the Seattle Heart Failure Model (SHFM) of < 80%
Heart Failure Survival Score (HFSS) in the high/medium risk range

Role of Diagnostic Right Heart Catheterization

Right heart catheterization (RHC) should be performed on all adult candidates in preparation for listing for cardiac transplantation and periodically until transplantation.

Donor Criteria

Brain death declared
Age <45 (special exceptions)
No pre-existent heart disease
Few coronary artery disease risk factors
No untreated acute infections
No systemic malignancy
No cardiac trauma
Normal ECG
Normal echocardiogram
Negative HIV and Hepatitis screen

References

Template:WikiDoc Sources

@@ Line 8: / Line 8: @@
 The pre-transplantation evaluation includes-
-===
+===Cardiopulmonary stress testing to guide transplant listing===
-==Functional Capacity and Peak V02 (V02 Max)==
+Exercise capacity as assessed by VO2max is a dynamic objective variable that assesses cardiac reserve and peripheral adaptations to a reduced cardiac output much more accurately than NYHA classification.
-This objective metric is listed by the ACC/AHA heart failure guidelines as a critical measure in determining when to list someone for transplantation <ref>Gibbons, RJ, Balady, GJ, Bricker, JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002; 106:1883.</ref><ref>Hunt, SA, Abraham, WT, Chin, MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119:e391.</ref>. A normal peak V02 is > 20 ml/kg/min.  Older data from 1986 through 1989 identified and peak V02 of 14 ml/kg/min as a threshold for listing a patient <ref name="pmid1999029">{{cite journal |author=Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH, Wilson JR |title=Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure |journal=[[Circulation]] |volume=83 |issue=3 |pages=778–86 |year=1991 |month=March |pmid=1999029 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=1999029}}</ref>. Those patients with a peak V02 > 14 ml/kg/min who were considered too stable for cardiac transplantation had a survival that was similar to that of patients with a peak V02 <u><</u> 14 ml/kg/min who were transplanted.  It should be noted that peak V02 is variable, and should be re assessed periodically.  It should also be noted that gender, age, comorbidities, and a patient's level of conditioning should be taken into account when interpreting the peak V02.  If a patient is consistently in the peak V02 range of 10-12 ml/kg/min, then transplantation should be considered.
-==Transplant Criteria==
+A maximal cardiopulmonary exercise test is defined as one with a respiratory exchange ratio (RER) > 1.05 and achievement of an anaerobic threshold on optimal pharmacologic therapy.
-'''''The ACC / AHA criteria are as follows <ref>Hunt, SA, Abraham, WT, Chin, MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119:e391.</ref>:'''''
-====Absolute Indications====
+===Use of Heart Failure prognosis scores===
-*For hemodynamic compromise due to severe [[heart failure]]
+* Seattle Heart Failure Model (SHFM) - An estimated 1-year survival as calculated by the Seattle Heart Failure Model (SHFM) of < 80%
-:*Refractory [[cardiogenic shock]]
+* Heart Failure Survival Score (HFSS) in the high/medium risk range
-:*Documented dependence on intravenous [[inotropic]] support to maintain adequate organ perfusion
-:*[[Peak VO2]] less than 10 mL/kg per min with achievement of anaerobic metabolism
-*Severe symptoms of ischemia that consistently limit routine activity and are not amenable to [[coronary artery bypass surgery]] or percutaneous coronary intervention.
-*Recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities
-====Relative indications====
+===Role of Diagnostic Right Heart Catheterization===
+* Right heart catheterization (RHC) should be performed on all adult candidates in preparation for listing for cardiac transplantation and periodically until transplantation.
+*
-#Peak V02 of 11 to 14 mL/kg per minute (or 55 percent predicted) and major limitation of the patient's daily activities
-#Recurrent unstable ischemia not amenable to other intervention
-#Recurrent instability of fluid balance/renal function not due to patient noncompliance with medical regimen
-===="Insufficient" indications====
-#Low left ventricular ejection fraction
-#History of functional class II or IV symptoms of HF
-#Peak [[VO2]] greater than 15 mL/kg per minute (or greater than 55 percent predicted) without other indications
 ==Donor Criteria==