Kriteria Transplantasi Jantung
Patients with severe heart failure with a limited life expectancy might be considered candidates for heart transplantation. The conventional criteria for consideration of heart transplantation for patients suffering from heart failure include advanced heart failure (NYHA III–IV) with objective evidence indicating severe limitation of functional ability and an estimated poor 1-month prognosis in the face of optimized or maximized medical therapy, low-output state or refractory cardiac failure requiring frequent or constant use of inotropes, cardiogenic shock or low-output hemodynamic state with reversible end-organ dysfunction requiring mechanical circulatory support, recurrence of or rapidly progressing heart failure unresponsive to optimized or maximized vasodilator and diuretic therapies.
The shortage of donor hearts, however, makes transplantation unavailable to most patients with end-stage heart failure, and many patients die while waiting for a donor organ. Furthermore, the stringent criteria used to select potential candidates make many patients ineligible. The qualification criteria are intended to identify the patients who are at highest risk and who may derive the greatest benefit from heart transplantation. Some patients, however, spontaneously improve while waiting for a suitable donor; this improvement has been accompanied by prolonged survival during the relatively short follow-up period. Furthermore, advances in medical and surgical therapies have been associated with improvement in clinical outcomes for patients with advanced heart failure. Compared with 10–20 years ago, these newer drug therapies have cast some uncertainty over the benefits of cardiac transplantation compared with other treatment options in advanced heart failure.
Current Diagnosis & Treatment Cardiology 3rd Edition (McGraw-Hill) 2009