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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 2 مورد

Contraindications to cardiac transplantation

Contraindications to cardiac transplantation
Absolute contraindications
  • Systemic illness with a life expectancy <2 years despite heart transplantation
  • Irreversible pulmonary hypertension with pulmonary vascular resistance >3 Wood Units (>240 dynes-sec/cm5)*[1]
  • Clinically severe symptomatic cerebrovascular disease
  • Active substance (drug or alcohol) abuse
  • Multiple demonstrations of inability to comply with drug therapy
  • Multisystem disease with severe extracardiac organ dysfunction
Relative contraindications
  • Age >70 years
  • Obesity (ie, body mass index >35 kg/m2)
  • Diabetes mellitus with poor glycemic control (glycated hemoglobin [HbA1c] >7.5% or 58 mmol/mol) despite optimal effort or end-organ damage other than non-proliferative retinopathy
  • Irreversible renal dysfunction (eGFR <30 mL/min/1.73 m2)Δ
  • Neoplasm (requires individualized assessment of severity, treatment options, and prognosis)
  • Infection (requires individualized assessment of severity, treatment options, and prognosis)
  • Acute pulmonary embolism (within six to eight weeks)
  • Tobacco use (within 6 months)
  • Recent past (within 6 months) substance (drug or alcohol) abuse
  • Inadequate social support or cognitive-behavioral disability that would prevent compliant care
  • Other conditions that increase the risk of perioperative complications or limit tolerance of immunosuppression (eg, peripheral vascular disease that would limit rehabilitation and is not amenable to revascularization, active peptic ulcer disease, cholelithiasis, diverticulosis, advanced hepatic disease)

* Patients with PVR up to 5 Wood units can be considered for cardiac transplantation on a case by case basis.

¶ While age >70-years-old is a relative contraindication, carefully selected >70-years-old may be considered for transplantation.

Δ For patients with renal dysfunction, evaluation should be undertaken to exclude reversible causes. Combined heart-kidney transplantation may be offered to those who require transplantation of both organs.
Adapted from:
  1. Mancini D, Lietz K. Selection of cardiac transplantation candidates in 2010. Circulation 2010; 122:173.
  2. Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant 2016; 35:1.
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