Criteria for Cardiac Transplantation

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. 

Criteria for Cardiac Transplantation

End-stage heart disease with poor (6–12 month) prognosis and refractory to aggressive tailored medical or any other surgical treatment NYHA functional class III or IV Age 60–65 years (various programs) Pulmonary vascular resistance < 3 RU or < 2.5 RU after intravenous nitroprusside Strong self-motivation and psychosocial support Absence of   Malignancy   Active infection   Active peptic ulcerative disease   Pulmonary infarction within 6 weeks   Advanced insulin-dependent diabetes mellitus with end-organ damage (relative)   Kidney or liver dysfunction beyond that expected from severe CHF   Advanced peripheral vascular disease    Collagen vascular diseases   Active alcoholism or substance abuse

CHF, congestive heart failure; NYHA, New York Heart Association; RU, resistance units.

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.

Referensi: 
Current Diagnosis & Treatment Cardiology 3rd Edition (McGraw-Hill) 2009

Tags: Lecture Notes