Heart transplantation contraindications: Difference between revisions
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===Relative Contraindications due to associated comorbidities=== | ===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. | <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'''- BMI > 35 kg/m 2 is associated with a worse outcome. | * '''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. | * '''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 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 | * '''Renal dysfunction'''- Irreversible renal dysfunction ( eGFR < 30 ml/min/1.73 m 2) is a relative contraindication | ||
Revision as of 10:30, 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
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. [2]
- 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
- ↑ 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.