Indications for Heart Transplantation

In general, pediatric and adult patients with advanced irreversible heart failure, on maximal medical therapy with a limited life expectancy should be considered for transplantation evaluation. Patients with increasing medication requirements, frequent hospitalizations or overall deterioration of clinical status should be considered.

The causes of congestive heart failure that result in heart transplantation are primary cardiomyopathy, coronary artery disease, or inoperable ischemic coronary disease with arrhythmias. A small percentage of patients who undergo heart transplantation do so for valvular heart disease, congenital heart disease, and inoperable hypertrophic cardiomyopathy.

A suitable heart transplant candidate should at a minimum meet the following criteria:

  • Cardiac disease, NYHA advanced Class III or Class IV;
  • Condition is not amenable to other forms of medical or surgical therapy;
  • Endstage cardiac disease with less than a 25% likelihood of survival at one year without a transplant.
  • Patients with potentially fatal arrhythmia not amenable to other therapies.

It is important that candidates be in, otherwise, good health and be without serious medical illness.

Factors That Can Rule Out Heart Transplantation

Relative Factors:
  • Unusual weight loss
  • Drug or alcohol abuse
  • Cigarette smoking
  • Advanced age (over 65 years). However, the physiological age of the candidate rather than the chronological age is the major consideration.
  • Severe cachexia.
  • Psychiatric illness which may interfere with compliance.
  • Morbid obesity.
  • Advanced, generalized atherosclerosis; severe peripheral vascular disease.
  • Diabetes Mellitus in poor control.
  • History of cancer (detailed information needed for evaluation).
Absolute Factors:
  • Fixed pulmonary hypertension (as reflected by a calculated pulmonary resistance above 6 Wood units, or a pulmonary arteriolar gradient greater than 15mm.)
  • Active systemic infection
  • Severe cerebral or carotid vascular disease not amenable to surgery.
  • Severe chronic obstructive pulmonary disease or severe chronic bronchitis.
  • Irreversible and severe hepatic or renal dysfunction (unless combined transplant is possible).
  • Active Malignancy
  • Unmanageable and/or severe psychiatric disease.
  • The patient (or parent if the patient is a child) is unable to understand the issues related to transplant and unable or unwilling to take medications as instructed.
  • Active peptic ulcer disease.
  • Substance addictions including tobacco use.