Heart transplantation contraindications: Difference between revisions
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<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> | <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 | *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 | **Active or recent solid organ or blood [[malignancy]] in the last 5 years | ||
**AIDS complicated by frequent opportunistic | **[[HIV AIDS|AIDS]] complicated by frequent [[opportunistic infection]]<nowiki/>s | ||
**Active diseases with multisystem involvement like- systemic lupus erythematosus, | **Active diseases with [[Multisystem organ failure|multisystem]] involvement like- [[systemic lupus erythematosus]], [[sarcoidosis]], or [[amyloidosis]] | ||
**Irreversible renal or hepatic dysfunction | **Irreversible [[renal]] or [[Hepatic failure|hepatic dysfunction]] | ||
**Significant obstructive pulmonary disease | **Significant [[obstructive pulmonary disease]] | ||
*Fixed or irreversible pulmonary hypertension | *Fixed or irreversible [[pulmonary hypertension]] | ||
**Pulmonary artery systolic pressure >60 mm Hg | **Pulmonary artery systolic pressure >60 mm Hg | ||
**Mean transpulmonary gradient >15 mm Hg | **Mean transpulmonary gradient >15 mm Hg | ||
**Pulmonary vascular resistance >6 Wood units | **[[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> | ||
*'''Age''' - Patients are considered for cardiac transplant if they are < 70 years of age; or carefully selected patients over age 70. | *'''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. | * '''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> | * '''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 control (glycosylated hemoglobin [HbA 1c] > 7.5% or 58 mmol/mol) are relative contraindications | * '''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 dysfunction'''- Irreversible renal dysfunction ( eGFR < 30 ml/min/1.73 m 2) is a relative contraindication | * '''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. | * '''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. | * '''Infections'''- Use of [[Immunosuppressive therapy|immunosuppressive]] therapy post-transplantation may cause a flare up of active [[Infection|infections]]. | ||
** Human immunodeficiency viral (HIV) infection | **[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency viral (HIV) infection]] | ||
** Chagas disease | **[[Chagas disease]] | ||
** Tuberculosis | **[[Tuberculosis]] | ||
** Hepatitis B and C viral (HBV and HCV) infections | **[[Hepatitis B]] and [[Hepatitis C|C]] viral (HBV and HCV) infections | ||
* '''Tobacco use'''- Active tobacco smoking is a relative contraindication. | * '''[[Tobacco Use Disorder|Tobacco]] use'''- Active tobacco smoking is a relative contraindication. | ||
* '''Substance Abuse'''- Active substance abusers (including alcohol) cannot receive a heart transplant. | *[[Substance abuse|'''Substance Abuse'''-]] Active substance abusers (including [[Alcohol, Drug Abuse, and Mental Health Services Block Grant|alcohol]]) cannot receive a heart transplant. | ||
* '''Psychosocial evaluation'''- | * '''[[Psychosocial|Psychosocial evaluation]]'''- Lack of social support of presence of [[Cognitive|cognitive disability]] are relative contraindications. | ||
==References== | ==References== | ||
Revision as of 11:13, 8 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 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
- 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.