Surgery
Heart Transplant
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Heart Transplant
, Cardiac Transplantation
Indications
Cardiomyopathy
Refractory
Heart Failure
(
NYHA Class
III to IV)
Refractory
Angina
or
Arrhythmia
s (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
Arrhythmia
s
Management
Anti-rejection protocol
Trials of newer protocols include
Tacrolimus
or
Sirolimus
Typically 3 drug protocol
Calcineurin Inhibitor
Mycophenolate mofetil
(
Cellcept
)
Corticosteroid
s for first 6 months
Management
Routine care following
Transplantation
Routine management of comorbidity (e.g.
Diabetes Mellitus
)
Osteoporosis
Annual complete physical
Malignancy screening
Keep
Vaccination
s up-to-date (Avoid
Live Vaccine
s)
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,
Statin
s, 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
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