Heart transplantation contraindications
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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.
- 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.