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COVID-19 Update

Due to interest in the COVID-19 vaccines, we are experiencing an extremely high call volume. Please understand that our phone lines must be clear for urgent medical care needs. We are unable to accept phone calls to schedule COVID-19 vaccinations at this time. When this changes, we will update this website. Our vaccine supply remains limited. Read all COVID-19 Vaccine Information.

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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

Call us to speak with any member of our transplant team regarding organ and tissue-specific transplants, how to refer a patient or our patient selection criteria.

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