HEART

TRANSPLANTATION
JOHN CHRISTOPHER A. ASILO, RPH

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 Heart Transplantation

■ Treatment of choice for selected patients with advanced heart failure.

■ It is the procedure by which the failing heart is replaced with another heart from a
suitable donor.
■ The annual frequency of heart transplantation is about 1% of the general population
with heart failure, both candidates or non-candidates.
■ Improved medical management of CHF has decreased the candidate population;
however, organ availability remains an issue.
■ The normal survival rate after cardiac transplantation is as high as 81.8%, with a five
year survival rate of 69.8%.

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Heart Transplantation

■ Candidacy determination and evaluation are key components of the process, as are post
operative follow-up care and immunosuppression management.
■ Candidates for cardiac transplantation generally present with New York Heart
association Class III symptoms or Class IV symptoms.
■ Interim Therapy can include oral agents as well as inotropic support.

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Indication
■ Patients with End-Stage Congestive Heart Failure
– Patients who have less than 1 year to live without the transplant.
– Candidates for or have not been helped by conventional medical therapy.
■ Due to Heart’s poor condition, most heart transplantation patients are excluded from
surgical option, specific indications for transplant are as follows:
– Dilated Cardiomyopathy
– Ischemic Cardiomyopathy
– Ejection fraction of less than 20%
– Intractable Angina or Malignant Cardiac Arrythmias
– Pulmonary Vascular resistance of less than 2 units.
– Age younger than 65 yers old
– Ability to comply with medical follow-up care

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Work Up: Laboratory Studies

■ Laboratory Studies
– Virus: Including hepatitis viruses, HIV, Epstein- Barr Virus, & Cytomegalovirus
– Fungus and Tuberculosis
– Prostate- Specific Antigen
– Papanicolaou Test
– Complete Blood Count
– Blood Typing and Screening, Panel-Reactive Antibody Testing and Tissue Typing

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Work Up: Imaging Studies

■ Imaging Studies
– Coronary Arteriography
– Echocardiography
– Postanterior and Lateral Chest Radiograph
– Bilateral Mammograms

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Work Up: Cardiac and Pulmonary
Evaluation
■ Cardiac & Pulmonary Evaluation
– Maximal venous oxygen consumption
– Right and Left Heart Catheterization
– Pulmonary Vascular Resistance

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Work Up: Biopsy

■ Biopsy
– Endomyocardial Biopsy

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Heart Transplantation: Contraindication

■ Age greater than 65 Years Old

■ Fixed pulmonary vascular Resistance of greater than 4 wood units
■ Active systemic Infection
■ Active Malignancy
■ An Ongoing history of substance abuse
■ Pschological Instability
■ Inability to comply with medical follow-up

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Transplantation Procedures:

■ Heterotrophic Heart Transplantation

■ Orthotopic Heart Transplantation
– Shumway- Lower Technique
– Bicaval Anastomosis

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Heart Transplantation: Complication

■ Complications
– Bleeding from suture lines
– Hyperacute rejection
– Infection
– Psychiatric disturbances from steroid therapy
– Cardiac rejection
– Allograft Vascular Disease

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Disease Processes Necessitating Heart
Transplantation
■ Dilated Cardiomyopathy (54%)
■ Ischemic Cardiomyopathy (45%)
■ Congenital Heart Disease (1%)

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Immunosuppresive Therapy

■ Immunosuppression is started soon after surgery.

■ Pretransplantation Induction Therapy
■ Post Operative Maintenance Therapy

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Future and Controversies

■ The future of cardiac transplantation will be determined by the outcomes of several

issues.
– Ongoing shortage of donor organs, which has fueled a search for alternative
therapies for the failing heart.
■ Alternative Therapies:
– Artificial assist device
– Dual- Chamber Pacing
– New Drug Intervention
– Genetic Therapy

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Future and Controversies

■ Another issue is the question of recipient selection and listing status , which continues
to pose medical and ethical dilemmas.
■ Final Issue is FINANCIAL!

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 Future and Controversies

■ CRITERIA: 2016 International Society of Heart Lung Transplantation

– Heart Failure prognosis scores should be performed along with cardiopulmonary
exercise testing to determine prognosis and guide listing for transplantation for
ambulatory patients.
– Patients should not be listed solely on the criteria of heart failure survival
prognostic scores
– Right Heart Catheterization
– Clinically Severe Symptomatic cerebrovascular disease may be considered a
contraindication to transplantation
– Mechanical Circulatory Support

Klein, A. (2011). Organ Transplantation: A Clinical Guide. [online] Emedicine.medscape.com.

Available at: https://emedicine.medscape.com/article/429499-overview#a1 [Accessed 22 Jun. 2019].

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 **END OF HEART TRANSPLANTATION**

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