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Heart Transplant
Aka: Heart Transplant, Cardiac Transplantation
- Indications
- Cardiomyopathy
- Refractory Heart Failure (NYHA Class III to IV)
- Refractory Angina or Arrhythmias (uncommon)
- Hemodynamic instability
- Peak VO2 <14 ml/kg/min
- Contraindications: Relative
- Age over 65 to 70 years
- Limited survival due to systemic illness
- Fixed Pulmonary Hypertension (PVR >5 Woods units)
- Malignancy
- HIV Infection
- Hepatitis B infection
- Hepatitis C infection
- Malignancy within the last 5 years
- Protocol
- Virtual cross-matching (prescreen via computer known HLA mismatches)
- Transplant at a large volume center if match found
- All Heart Transplant centers perform at least 10 transplants per year
- Large volume centers perform upwards of 30 transplants per year
- Precautions: Observe
- Diarrhea (may require change in anti-rejection medications)
- Signs of infection (e.g. Fever or Leukocytosis)
- Signs of rejection
- New signs of Heart Failure or Left Ventricular Dysfunction
- Arrhythmias
- Management: Anti-rejection protocol
- Trials of newer protocols include Tacrolimus or Sirolimus
- Typically 3 drug protocol
- Calcineurin Inhibitor
- Mycophenolate mofetil (Cellcept)
- Corticosteroids for first 6 months
- Management: Routine care following Transplantation
- Routine management of comorbidity (e.g. Diabetes Mellitus)
- Osteoporosis
- Annual complete physical
- Malignancy screening
- Keep Vaccinations up-to-date (Avoid Live Vaccines)
- Pneumovax every 2-5 years
- Influenza annually
- HPV Vaccine for younger women
- Adverse effects: Top causes of death
- Malignancy
- Graft failure
- Cardioac Allograft vasculopathy
- Patient monitored lifelong for this after transplant
- Treated with Cardiac Risk reduction, Statins, revascularization, CMV prevention
- Prognosis
- HLA mismatch decreases survival and in proportion to the number of HLA mismatches
- Survival half-life following Cardiac Transplantation
- Overall survival: 10 year half-life
- Survival beyond 1 year: 13 year half-life
- University of Minnesota data as of 2009
- Survival at 1 year: 87%
- Survival at 3 years: 79%
- Survival at 5 years: 72%
- References