Heart transplantation criteria

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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]

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

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,
  • few laboratory values

SHFM model has also incorporated the impact of newer HF therapies on survival, including ICDs and CRT.

1. Heart Failure Survival Score (HFSS) in the high/medium risk range

The predictors of survival in the HFSS include:

• • 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.

1. Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score

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

1. Brain death declared
2. Age <45 (special exceptions)
3. No pre-existent heart disease
4. Few coronary artery disease risk factors
5. No untreated acute infections
6. No systemic malignancy
7. No cardiac trauma
8. Normal ECG
9. Normal echocardiogram
10. Negative HIV and Hepatitis screen

References

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