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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

Contact us for more information on heart transplants at Johns Hopkins.

 

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