Cardiac Transplant

Overview
Cardiac Transplant occurs roughly 5000x/yr (some countries do not document)
In the last 20 yrs, patients on transplant list are living longer due to medical management: ace inh, bb, spironolactone, and Cardiac resynchronization devices. This makes it much more important to ensure that the risk of transplant outweighs the the patient's expected mortality pre-transplant

• Indications:
  • For hemodynamic compromise due to HF:
    • Refractory cardiogenic shock
    • Documented dependence on intravenous inotropic support to maintain adequate organ perfusion
    • Peak VO2 less than 10 mL/kg per min with achievement of anaerobic metabolism
  • Severe symptoms of ischemia that consistently limit routine activity and are not amenable to coronary artery bypass surgery or percutaneous coronary intervention.
  • Recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities
• Relative indications include:
  • V02 >10 but <14
  • difficulty maintaining fluid balance and renal dysfunction
    

Overview of Contraindications to Cardiac Transplant:
High Pulmonary Vascular resistance
Malignancy
Infection ie) HIV
Age (<65 at most institutions but variable)
Organ Failure
Social history: support system, substance abuse
Signifcant Mental Health disease ie) Dr Friday gave example of pedophile with poor social support who was declined at SUH

• Review of common infections in Solid Organ Transplant recipients based on time post-transplant (timeline attached):
  • <1 month
    • MRSA, VRE
    • Candida (non-albicans)
    • cdiff
    • in addition to common post op sources like wounds, anastamosis leaks, catheter infections, aspiration pna
      
  • 1-6mos
    • polyomyvirus BK
    • C diff
    • HCV
    • Adenovirus, Influenza
      
  • >6mos
    • CAP, UTI
    • aspergillus
    • mucor
    • nocardia

Reference: Fishman, JA. Infection in solid-organ transplant recipients. N Engl J Med 2007; 357:2601

(Ellen Eaton MD, 9/24/10)