Abstract
Cardiac transplant candidate selection involves the use of prognostic variables to identify patients with end-stage heart failure, combined with a series of empirically derived contraindications to exclude those patients with probable poor outcome from significant comorbidities or high perioperative risk. Candidate selection assumes that the treating physician has a thorough understanding of the prognosis and management of patients with end-stage heart disease. This chapter reviews the transplant evaluation process with an emphasis on cardiopulmonary exercise testing and the use of multivariable models to predict survival. Contraindications to transplant are outlined. Discussion of serial assessment of transplant candidates, criteria for removal of patients from the transplant list, retransplantation, and alternative listing are included.
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References
Kannel WB. Epidemiologic aspects of heart failure. Cardiol Clinics 1987; 7: 1–9.
Rose E, Gelijns A, Moskowitz A, et al. Long term use of left ventricular device for end-stage heart failure. (REMATCH). N Engl J Med 2001; 345: 1435–1443.
Hunt S, Baker D, Chin M, et al. ACC/AHA Guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. Circulation 2001; 104: 2996–3007.
Costanzo M, Augustine S, Bourge R, et al. Selection and treatment of candidates for heart transplanatation. Circulation 1995; 92: 3593–3612.
Mancini D, Ascheim D, Ronan N, Predictors of survival in patients with end-stage heart failure. Circulation 2002;106(19):II680.
Lang C, Beniaminovitz A, Edwards N, et al. Morbidity and mortality in diabetic patients following cardiac transplantation. J Heart Lung Transplant 2003; 22: 244–249.
Cohn J, Johnson G, Shabetai R,Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinates of prognosis in heart failure. The V-Heft VA Cooperative Studies Group. Circulation 1993;87:VI5–VI16.
Lee W, Packer M. Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. Circulation 1986; 73: 257–267.
Saxon L, Stevenson W, Middlekauf H, et al. Predicting death from progressive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1993; 72: 62–65.
Weber K, Kinasewitz G, Janicki J, et al. Oxygen utilization and ventilation during exercise in patients with chronic congestive heart failure. Circulation 1982; 65: 1213–1223.
Szlachcic J, Massie B, Kramer B, et al. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol 1985; 55: 1037–1042.
Mancini DM, Eisen H, Kussmaul W, et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991; 83: 778–786.
Aaronson KD, Mancini DM. Is percentage of predicted maximal exercise oxygen consumption a better predictor of survival than peak exercise oxygen consumption for patients with severe heart failure? J Heart Lung Transplant 1995; 14: 981–989.
Stelken AM, Younis LT, Jennison SH, et al. Prognostic value of cardiopulmonary exercise testing using percent achieved of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy. J Am Coll Cardiol 1996; 27: 345–352.
Aaronson K, Chen T, Mancini D. Demonstration of the continuous nature of peak VO2 for predicting survival in ambulatory patients evaluated for transplant. J Heart Lung Transplant 1996;15:S66S.
Chomsky DB, Lange CC, Rayos GH, et al. Hemodynamic exercise testing: a valuable tool in the selection of cardiac transplantation candidates. Circulation 1996; 94: 3176–3183.
Mancini D, Katz S, Donchez L, et al. Coupling of hemodynamic measurements with oxygen consumption during exercise does not improve risk stratification in patients with heart failure. Circulation 1996; 94: 2492–2496.
Osado N, Bernard CR, Miller LW, et al. Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. J Am Coll Cardiol 1998; 31: 577–582.
Chua TP, Ponikowski P, Harrington D, et al. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol 1997; 29: 1585–1590.
Aaronson K, Schwartz JS, Chen T, et al. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997; 95: 2660–2667.
Peterson L, Schechtman K, Ewald G, et al. The effect of ß-adrenergic blockers on the prognostic value of peak exercise oxygen uptake in patients with heart failure. J Heart Lung Transplant 2003; 22: 70–77.
Powhani A, Murali S, Mathier M, et al. Impact of ß-blocker therapy on functional capacity criteria for heart transplant listing. J Heart Lung Transplant 2003; 22: 78–86.
Stevenson L, Steimle A, Fonarow G, et al. Improvement in exercise capacity of candidates awaiting heart transplantation. J Am Coll Cardiol 1995; 25: 163–170.
Aaronson K, Bowers J, Chen T, et al. Mortality remains high for outpatient transplant candidates with prolonged (=6 months) waiting list time. J Am Coll Cardiol 1999; 33: 1189–1195.
Aaronson K, Bowers J, Gonzalez J, et al. Heart failure survival model predicts survival when applied serially at subsequent reevaluation. J Heart Lung Transplant 1997; 17: 82A.
Lang C, Hankins S, Hauff H, et al. Morbidity and mortality of UNOS status IB cardiac transplant candidates at home. J Heart Lung Transplant 2003; 22: 419–426.
Mancini D, Oz M, Williams M. Cardiac transplantation/circulatory support devices. In: Antman E, ed. Cardiovascular Therapeutics, 2nd ed. WB Saunders, Philadelphia, PA: 2002, p. 390.
Williams M, Joshi N, Hankinson T, et al. LVAD insertion in patients without thorough transplant evaluations: a worthwhile risk? J Thoracic and Cardiovasc Surg 2003; 126 (2): 436–441.
Itescu S, Burke E, Lietz K, et al. Intravenous pulsed administration of cyclophosphamide is highly effective and safe for sensitized recipients of cardiac allograft recipents. Circulation 2002; 105: 1214–1219.
Chen J, Hammond K, Kherani A, et al. Is the alternate waiting list too high risk? The Columbia—Presbyterian Experience. J Heart Lung Transplant 2003; 22: 175.
Laks H, Marelli D. The alternate recipient list for heart transplantation: a model for expansion of the donor pool. Advances in Cardiac Surg 1999; 11: 233–244.
Laks H, Scholl FG, Drinkwater DC, et al. The alternate recipient list for heart transplantation: does it work? J Heart Lung Transplant 1997; 16: 735–742.
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© 2004 Humana Press Inc., Totowa, NJ
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Mancini, D.M., Kunavarapu, C. (2004). Recipient Selection. In: Edwards, N.M., Chen, J.M., Mazzeo, P.A. (eds) Cardiac Transplantation. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-758-1_1
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DOI: https://doi.org/10.1007/978-1-59259-758-1_1
Publisher Name: Humana Press, Totowa, NJ
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