Care of Heart Transplant Recipients Clinical Practice Guidelines (ISHLT, 2023)

International Society for Heart and Lung Transplantion

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 10, 2023

Updated guidelines for the care of heart transplant recipients were published in May 2023 by the International Society for Heart and Lung Transplantion (ISHLT) in J Heart Lung Transplant.{1]

Management of Cardiovascular Risk After Heart Transplantation

Therapies for short-term perioperative and long-term chronic glycemic control in heart transplant (HT) recipients should be based on contemporary guidelines. HT recipients with diabetes should be counseled regarding weight control, diet/nutrition, and exercise; and annual screening should be performed for diabetic complications.

Treatment of hypertension in HT recipients should include recommendations for lifestyle modifications (eg, weight loss, low-sodium diet, and exercise) in addition to drug therapy. Angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers may be preferred as first-line therapy in patients with diabetes and for preventing cardiac allograft vasculopathy (CAV); hydrochlorothiazide could be considered for specifically counteracting calcineurin inhibitor (CNI)-induced hypertension.

Biannual measurements of lipid levels should be performed in adult HT recipients. It is reasonable to target low-density lipoprotein (LDL) levels below 100 mg/dL (2.5 mmol/L), but close monitoring is required to watch for potential interactions between lipid-lowering therapies and immunosuppressive agents.

Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors and ezetimibe can be considered as adjuncts to statin therapy in HT recipients with uncontrolled hyperlipidemia or as primary therapy in those with statin intolerance.

It is reasonable to consider routine use of aspirin early after HT for prevention of CAV.

For more information, please go to Heart Transplantation, Pediatric Heart Transplantation, and Heart-Lung Transplantation.


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