Indications and Contraindications for Pediatric Transplantation

Referral Criteria for Pediatric Heart Transplantation

We welcome a call from physicians who are interested in discussing pediatric transplantation or potential indications or contraindications for a specific patient.  If you are a medical professional calling from a physician's office and would like to reach a Hopkins transplant physician, please feel free to reach us using any of the numbers listed below:

Pediatric Heart Transplantation Office (Monday-Friday, 8am? – 4pm?) 410-955-5910 or Hopkins Access Line for Physicians (24 hours, 7 days a week) 410-955-9444 or 1-800-765-JHHS

The criteria for the selection of potential heart transplantation candidates include the following:

• Objective evidence of advanced physical incapacitation due to documented, isolated heart or heart-lung disease.
• A limited life expectancy, estimated to be less than one year.
• Unanimous agreement that previous medical therapy has been optimal and that no other surgical procedure other than transplantation offers realistic expectation of functional improvement and extension of life.
• Strong family support to aid the patient emotionally during the period prior to and after surgery.

The following factors exert an adverse influence on the outcome of heart transplantation and therefore may be CONTRAINDICATIONS to surgery:

• Age of more than 65 years.
• Severe, irreversible pulmonary hypertension (greater than 5 Wood Units) for heart transplantation.
• Renal or hepatic dysfunction not explained by the underlying heart failure and deemed irreversible.
• Symptomatic peripheral or cerebrovascular disease.
• Chronic obstructive pulmonary disease.
• Active systemic infection.
• Recent or unresolved pulmonary infarction; pulmonary radiographic evidence of  infection or abnormalities of unclear etiology.
• Severe systemic hypertension inadequately controlled with medicines.
• Active peptic ulcer disease with recent gastrointestinal bleeding.
• Other systemic disease likely to limit or preclude survival and rehabilitation after transplantation.
• A history of behavior pattern or psychiatric illness considered likely to interfere significantly with compliance.

RELATIVE CONTRAINDICATIONS include:

• Insulin-dependent diabetes with evidence of significant target organ disease (retinopathy, nephropathy, neuropathy).
• Asymptomatic but severe peripheral or cerebrovascular disease.
• Current or recent history of diverticulitis