Heart transplantation criteria: Difference between revisions
Jump to navigation
Jump to search
Ifrah Fatima (talk | contribs) |
Ifrah Fatima (talk | contribs) No edit summary |
||
| Line 5: | Line 5: | ||
==Criteria for Cardiac Transplantation== | ==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. | While assessment of the [[Indications and usage|indications]] and [[Contraindication|contraindications]] are important first steps in evaluating the appropriateness for [[Heart transplantation|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- | ||
The pre-transplantation evaluation includes- | |||
===Cardiopulmonary stress testing to guide transplant listing=== | ===Cardiopulmonary stress testing to guide transplant listing=== | ||
Exercise capacity is assessed by | [[Exercise capacity]] is assessed by VO2 max which represents the cardiac reserve and the peripheral manifestations in response to a reduced [[cardiac output]]. <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref> | ||
A maximal cardiopulmonary exercise test is | A maximal [[Cardiopulmonary exercise testing|cardiopulmonary exercise test]] is | ||
* Respiratory exchange ratio (RER) > 1.05 | * Respiratory exchange ratio (RER) > 1.05 | ||
* Achievement of an anaerobic threshold on optimal medical treatment | * Achievement of an anaerobic threshold on optimal medical treatment | ||
| Line 18: | Line 17: | ||
The following cutoff values of peak oxygen consumption (VO2) are used to guide listing in various cases- <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> | The following cutoff values of peak oxygen consumption (VO2) are used to guide listing in various cases- <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> | ||
* Patients intolerant of a β-blocker- Peak Vo 2 of ≤ 14 ml/kg/min | * Patients intolerant of a [[Beta blockers|β-blocker]]- Peak Vo 2 of ≤ 14 ml/kg/min | ||
* In the presence of a β-blocker- peak Vo 2 of ≤ 12 ml/kg/min | * In the presence of a [[Beta blockers|β-blocker]]- peak Vo 2 of ≤ 12 ml/kg/min | ||
* Young patients (< 50 years) and women- percent of predicted (≤ 50%) peak Vo 2 and using alternate standards in conjunction it | * Young patients (< 50 years) and women- percent of predicted (≤ 50%) peak Vo 2 and using alternate standards in conjunction with it | ||
* Sub-maximal cardiopulmonary exercise test (RER < 1.05)- use of ventilation equivalent of carbon dioxide (Ve/Vco 2) slope of > 35 | * Sub-maximal cardiopulmonary exercise test (RER < 1.05)- use of ventilation equivalent of [[carbon dioxide]] (Ve/Vco 2) slope of > 35 | ||
* Obese (body mass index [BMI] > 30 kg/m 2) patients- adjusting peak Vo 2 to lean body mass may be considered. A lean body mass–adjusted peak Vo 2 of < 19 ml/kg/min is used for listing. | *[[Obesity|Obese]] (body mass index [<nowiki/>[[Body mass index|BMI]]] > 30 kg/m 2) patients- adjusting peak Vo 2 to lean body mass may be considered. A lean body mass–adjusted peak Vo 2 of < 19 ml/kg/min is used for listing. | ||
===Use of Heart Failure prognosis scores=== | ===Use of Heart Failure prognosis scores=== | ||
| Line 31: | Line 30: | ||
* age | * age | ||
* sex | * sex | ||
* NYHA class | *[[NYHA functional Class|NYHA]] class | ||
* weight | * weight | ||
* ejection fraction | *[[ejection fraction]] | ||
* blood pressure | *[[blood pressure]] | ||
* medications | * medications | ||
SHFM model has also incorporated the impact of newer HF therapies on survival, including ICDs and CRT. | |||
SHFM model has also incorporated the impact of newer HF therapies on survival, including [[Implantable cardioverter defibrillator|ICDs]] and [[Cardiac resynchronization therapy|CRT]]. | |||
2. '''Heart Failure Survival Score (HFSS)''' in the high/medium risk range | 2. '''Heart Failure Survival Score (HFSS)''' in the high/medium risk range | ||
The predictors of survival in the HFSS include: <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref> | The predictors of survival in the HFSS include: <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref> | ||
*Presence or absence of coronary artery disease | *Presence or absence of [[Coronary heart disease|coronary artery disease]] | ||
*Resting heart rate | *Resting [[heart rate]] | ||
*Left ventricular ejection fraction | *[[Left ventricular ejection fraction]] | ||
*Mean arterial blood pressure | *Mean arterial blood pressure | ||
*Presence or absence of an intraventricular conduction delay on ECG | *Presence or absence of an intraventricular conduction delay on [[The electrocardiogram|ECG]] | ||
*Serum sodium | *Serum [[sodium]] | ||
*VO2max. | *VO2max. | ||
| Line 58: | Line 59: | ||
* Right heart catheterization (RHC) should be performed on all adult candidates in preparation for listing for cardiac transplantation and periodically (every 3-6 months, especially in the presence of reversible pulmonary hypertension or worsening symptoms of heart failure) until transplantation. | * Right heart catheterization (RHC) should be performed on all adult candidates in preparation for listing for cardiac transplantation and periodically (every 3-6 months, especially in the presence of reversible pulmonary hypertension or worsening symptoms of heart failure) until transplantation. | ||
* A vasodilator challenge should be administered if- | * A [[vasodilator]] challenge should be administered if- | ||
** the pulmonary artery systolic pressure is ≥ 50 mm Hg and | ** the pulmonary artery systolic pressure is ≥ 50 mm Hg and | ||
** Either the transpulmonary gradient is ≥ 15 or the pulmonary vascular resistance (PVR) is > 3Wood units while maintaining a systolic arterial blood pressure > 85 mm Hg | ** Either the transpulmonary gradient is ≥ 15 or the pulmonary vascular resistance (PVR) is > 3Wood units while maintaining a systolic arterial blood pressure > 85 mm Hg | ||
* When an acute vasodilator challenge is unsuccessful, the patient should be hospitalized with continuous hemodynamic monitoring and treated pharmacologically till the PVR | * When an acute vasodilator challenge is unsuccessful, the patient should be hospitalized with continuous hemodynamic monitoring and treated pharmacologically till the PVR declines. | ||
* Pulmonary Hypertension is considered irreversible if- | *[[Pulmonary hypertension|Pulmonary Hypertension]] is considered irreversible if- | ||
** Medical therapy fails to optimize the hemodynamics | ** Medical therapy fails to optimize the [[hemodynamics]] | ||
** If the left ventricle cannot be effectively unloaded with mechanical adjuncts, like an intra-aortic balloon pump (IABP) and/or left ventricular assist device (LVAD) | ** If the left ventricle cannot be effectively unloaded with mechanical adjuncts, like an [[intra-aortic balloon pump]] ([[Intra-aortic balloon pump|IABP]]) and/or [[left ventricular assist device]] (LVAD) | ||
==Donor Criteria== | ==Donor Criteria== | ||
Revision as of 11:23, 8 June 2020
|
Heart transplantation Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Heart transplantation criteria On the Web |
|
American Roentgen Ray Society Images of Heart transplantation criteria |
|
Risk calculators and risk factors for Heart transplantation criteria |
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 is assessed by VO2 max which represents the cardiac reserve and the peripheral manifestations in response to a reduced cardiac output. [1]
A maximal cardiopulmonary exercise test is
- Respiratory exchange ratio (RER) > 1.05
- Achievement of an anaerobic threshold on optimal medical treatment
The following cutoff values of peak oxygen consumption (VO2) are used to guide listing in various cases- [2]
- Patients intolerant of a β-blocker- Peak Vo 2 of ≤ 14 ml/kg/min
- In the presence of a β-blocker- peak Vo 2 of ≤ 12 ml/kg/min
- Young patients (< 50 years) and women- percent of predicted (≤ 50%) peak Vo 2 and using alternate standards in conjunction with it
- Sub-maximal cardiopulmonary exercise test (RER < 1.05)- use of ventilation equivalent of carbon dioxide (Ve/Vco 2) slope of > 35
- Obese (body mass index [BMI] > 30 kg/m 2) patients- adjusting peak Vo 2 to lean body mass may be considered. A lean body mass–adjusted peak Vo 2 of < 19 ml/kg/min is used for listing.
Use of Heart Failure prognosis scores
1. Seattle Heart Failure Model (SHFM) - An estimated 1-year survival as calculated by the Seattle Heart Failure Model (SHFM) of < 80%
The factors considered in this model are-
- age
- sex
- NYHA class
- weight
- ejection fraction
- blood pressure
- medications
SHFM model has also incorporated the impact of newer HF therapies on survival, including ICDs and CRT.
2. Heart Failure Survival Score (HFSS) in the high/medium risk range
The predictors of survival in the HFSS include: [1]
- Presence or absence of coronary artery disease
- Resting heart rate
- Left ventricular ejection fraction
- Mean arterial blood pressure
- Presence or absence of an intraventricular conduction delay on ECG
- Serum sodium
- VO2max.
3. Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score
Listing patients solely on the criteria of heart failure survival prognostic scores should not be performed. [2]
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 (every 3-6 months, especially in the presence of reversible pulmonary hypertension or worsening symptoms of heart failure) until transplantation.
- A vasodilator challenge should be administered if-
- the pulmonary artery systolic pressure is ≥ 50 mm Hg and
- Either the transpulmonary gradient is ≥ 15 or the pulmonary vascular resistance (PVR) is > 3Wood units while maintaining a systolic arterial blood pressure > 85 mm Hg
- When an acute vasodilator challenge is unsuccessful, the patient should be hospitalized with continuous hemodynamic monitoring and treated pharmacologically till the PVR declines.
- Pulmonary Hypertension is considered irreversible if-
- Medical therapy fails to optimize the hemodynamics
- If the left ventricle cannot be effectively unloaded with mechanical adjuncts, like an intra-aortic balloon pump (IABP) and/or left ventricular assist device (LVAD)
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
- ↑ 1.0 1.1 Alraies MC, Eckman P (2014). "Adult heart transplant: indications and outcomes". J Thorac Dis. 6 (8): 1120–8. doi:10.3978/j.issn.2072-1439.2014.06.44. PMC 4133547. PMID 25132979.
- ↑ 2.0 2.1 2.2 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.