Heart Transplant Patient Selection Criteria
Indications
- Orthotopic heart transplant
- End-stage heart disease not amenable to other medical or surgical therapy
Acceptable
- Maximal VO2 < 10 ml/kg/min with achievement of anaerobic metabolism
- Severe ischemia consistently limiting routine activity not amenable to revascularization
- Recurrent symptomatic ventricular arrhythmia refractory to all accepted therapeutic modalities
Probable
- Maximal VO2 < 14 ml/kg/min and major limitation of the patient’s daily activities.
- Recurrent unstable angina not amenable to revascularization
- Unstable fluid balance/renal function not due to patient noncompliance with regimen of weight monitoring, flexible use of diuretics and salt restriction
- Ross classification III-IV
- NYHA Class III-IV symptoms on optimal medical therapy and prognosis for 1 year survival less than 75%
- Heterotopic heart transplant
- End-stage heart disease not amenable to other medical or surgical therapy with irreversible pulmonary hypertension
- NYHA Class III-IV symptoms on optimal medical therapy and prognosis for 1 year survival less than 75%
- No underlying pulmonary disease
Contraindications
Absolute Contraindications
Absolute contraindications for adults and children include, but may not be limited to:
- Major systemic disease
- Age inappropriateness (70 years of age)
- Cancer in the last 5 years except localized skin (not melanoma) or stage I breast or prostate
- Active smoker (less than 6 months since quitting)
- Active substance abuse
- HIV
- Severe local or systemic infection
- Severe neurologic deficits
- Major psychiatric illness or active substance abuse that cannot be managed sufficiently to allow post-transplant care and safety
Relative Contraindications
Relative contraindications for adults and children include, but may not be limited to:
- Severe pulmonary hypertension with PAS > 60 mm Hg, TPG > 15 mm Hg, PVR > 3.5 Wood Units irreversible with milrinone
- Pulmonary dysfunction with FVC and FEV1 < 40% predicted especially with intrinsic lung disease on imaging
- Acute pulmonary thromboembolism
- Morbid obesity (>140% Ideal body weight. For males, 106 lbs. for first 5 ft of height then 6 lbs. for each additional inch. For women, 100 lbs. for first 5 feet of height then 5 lbs. for each additional inch)
- Irreversible hepatic dysfunction with bilirubin > 2.5 mg/dL and/or transaminases > 2 x normal, or cirrhosis on biopsy
- Irreversible renal dysfunction with creatinine clearance < 40-50 mL/min or ERPF < 200 mL/min (Effective Renal Plasma Flow)
- Documented severe peripheral or cerebrovascular disease
- Coexisting neoplasm or history of neoplasm other than skin within 5 years
- Insulin-requiring diabetes mellitus with end-organ damage
- Active peptic ulcer disease
- Current or recent diverticulitis
- Cachexia
- Inability to make a strong commitment to transplantation
- Absence of adequate external psychosocial supports for either short-term or long-term basis