1. Evaluation of a Heart Transplant Candidate
- Author
-
Shelley R. Hankins, Suk Keun Hong, Kyung-Hee Kim, and Sook Jin Lee
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Comorbidity ,030204 cardiovascular system & hematology ,Malignancy ,Severity of Illness Index ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,medicine ,Lung transplantation ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Referral and Consultation ,Selection (genetic algorithm) ,Heart transplantation ,Heart Failure ,business.industry ,Patient Selection ,medicine.disease ,Prognosis ,Tissue Donors ,Transplantation ,Heart failure ,Candidacy ,Heart Transplantation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Heart transplantation is the best option for irreversible and critically advanced heart failure. However, limited donor pool, the risk of rejection, infection, and right ventricular dysfunction in short-term post-transplant period, as well as, the development of coronary allograft vasculopathy and malignancy in the long-term post-transplant period limits the utility of heart transplantation for all comers with advanced heart failure. Therefore, selection of appropriate candidates is very important for the best short and long-term prognosis. In this article, we discuss the principles of selection of candidates and compare to the recently updated International Society for Heart and Lung Transplantation (ISHLT) listing criteria with the goal of updating current clinical practice. We found that while most of the recommendations in the new listing criteria are continuous with the previous criteria, updated recommendations are made on the risk stratification models in choosing transplantation candidates. Recommendation on hepatic dysfunction is not directly included in the updated ISHLT listing criteria; however, adoption of the Model for End-stage Liver Disease (MELD) score and modified MELD scores in the evaluation of risk are suggested in recent studies. In conclusion, evaluation of patient selection for heart transplantation should be comprehensive and individualized with respect to indications and the risk of comorbidities of candidates. With the advancement of mechanical circulatory support (MCS), the selection of heart transplantation candidate is continuously evolving and widened. MCS as bridge to candidacy should be considered when the candidate has potentially reversible risk factors for transplantation.
- Published
- 2017