Fast Five Quiz: Organ Donation and Transplant

Beje Thomas, MD; Soon Youn Yi, MD

Disclosures

December 06, 2018

The 2016 International Society for Heart Lung Transplantation updated criteria for heart transplantation are:

  • Heart failure prognosis scores should be performed along with cardiopulmonary exercise testing to determine prognosis and guide listing for transplantation for ambulatory patients. An estimated 1-year survival of <80%, as calculated by the Seattle Heart Failure Model, or a Heart Failure Survival Score in the high/medium risk range should be considered as reasonable cut points for listing. Patients should not be listed solely on the criteria of heart failure survival prognostic scores

  • Retransplantation is indicated for those patients who develop significant cardiac allograft vasculopathy with refractory cardiac allograft dysfunction without evidence of ongoing rejection

  • Pretransplant BMI >35 kg/m2 is associated with a worse outcome after cardiac transplantation; for such obese patients, recommend weight loss to achieve a BMI of ≤35 kg/m2 before listing for cardiac transplantation

  • RHC should be performed on all adult candidates in preparation for listing for cardiac transplantation and periodically until transplantation

  • After left ventricular assist device, reevaluation of hemodynamics should be done after 3-6 months to ascertain reversibility of pulmonary hypertension

  • Clinically severe symptomatic cerebrovascular disease may be considered a contraindication to transplantation

  • Assessment of frailty (three of five possible symptoms, including unintentional weight loss of ≥10 lb within the past year, muscle loss, fatigue, slow walking speed, and low levels of physical activity) may be considered when assessing candidacy

  • Use of mechanical circulatory support should be considered for patients with potentially reversible or treatable comorbidities such as cancer, obesity, renal failure, tobacco use, and pharmacologically irreversible pulmonary hypertension, with subsequent reevaluation to establish candidacy

  • Any patient for whom social supports are deemed insufficient to achieve compliant care in the outpatient setting may be regarded as having a relative contraindication to transplant. The benefit of heart transplantation in patients with severe cognitive-behavioral disabilities or dementia (eg, self-injurious behavior, inability to ever understand and cooperate with medical care) has not been established and has the potential for harm; therefore, heart transplantation cannot be recommended for this subgroup of patients

For more on heart transplantation, read here.

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