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Evaluation of a Heart Transplant Candidate

  • Heart Failure (HJ Eisen, Section Editor)
  • Published:
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Abstract

Purpose of Review

Heart transplantation is the best option for irreversible and critically advanced heart failure. However, limited donor pool, the risk of rejection, infection, and right ventricular dysfunction in short-term post-transplant period, as well as, the development of coronary allograft vasculopathy and malignancy in the long-term post-transplant period limits the utility of heart transplantation for all comers with advanced heart failure. Therefore, selection of appropriate candidates is very important for the best short and long-term prognosis. In this article, we discuss the principles of selection of candidates and compare to the recently updated International Society for Heart and Lung Transplantation (ISHLT) listing criteria with the goal of updating current clinical practice.

Recent Findings

We found that while most of the recommendations in the new listing criteria are continuous with the previous criteria, updated recommendations are made on the risk stratification models in choosing transplantation candidates. Recommendation on hepatic dysfunction is not directly included in the updated ISHLT listing criteria; however, adoption of the Model for End-stage Liver Disease (MELD) score and modified MELD scores in the evaluation of risk are suggested in recent studies.

Summary

In conclusion, evaluation of patient selection for heart transplantation should be comprehensive and individualized with respect to indications and the risk of comorbidities of candidates. With the advancement of mechanical circulatory support (MCS), the selection of heart transplantation candidate is continuously evolving and widened. MCS as bridge to candidacy should be considered when the candidate has potentially reversible risk factors for transplantation.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, 489, 28 Hohyun-ro, Bucheon-shi, Kyungki Province, 14754, South Korea

    Sook Jin Lee, Kyung Hee Kim & Suk Keun Hong

  2. Division of Cardiology, Drexel University College of Medicine, 245N. 15th street, Philadelphia, PA, 19102, USA

    Shelley Hankins

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  1. Sook Jin Lee
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  2. Kyung Hee Kim
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  3. Suk Keun Hong
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  4. Shelley Hankins
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Correspondence to Shelley Hankins.

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Sook Jin Lee, Kyung Hee Kim, Suk Keun Hong, and Shelley Hankins declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Heart Failure

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Lee, S.J., Kim, K.H., Hong, S.K. et al. Evaluation of a Heart Transplant Candidate. Curr Cardiol Rep 19, 133 (2017). https://doi.org/10.1007/s11886-017-0934-y

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