Page 4 - Heart Transplant Guidelines
P. 4

Heart Function Service: Heart Transplant Guidelines



               Preface .......................................................................................................................................................... 3
               Transplant Evaluation ................................................................................................................................... 8

                  Role of Each Consult Service during Pre-Transplant Evaluation ............................................................... 8
                  Indications and Contraindications to Transplant & Re-transplant ......................................................... 10

                  Donor Offers ........................................................................................................................................... 11
                  ABO-Incompatible Heart Transplantation .............................................................................................. 11

                  HLA-Incompatible Heart Transplantation ............................................................................................... 14

                    Desensitization Guideline ................................................................................................................... 15
                    Guideline for Patients with a Positive Retrospective Cross-Match .................................................... 16

               Immunosupression ..................................................................................................................................... 17
                  Pre-Transplant Immunosuppression Orders ........................................................................................... 17

                  Post-Transplant Immunosuppression Guidelines ................................................................................... 17
                  Maintenance Immunosuppression ......................................................................................................... 18

                    Mycophenolate Mofetil (Cellcept) ...................................................................................................... 18
                    Prograf (Tacrolimus)............................................................................................................................ 19

                    Sirolimus (Rapamycin) ........................................................................................................................ 19
                    Azathioprine (Imuran) ......................................................................................................................... 19

                    Cyclosporine ........................................................................................................................................ 19

               Rejection ..................................................................................................................................................... 19
                  Surveillance (Protocol) Biopsies .............................................................................................................. 20

                  Acute Cardiac Cellular Rejection ............................................................................................................. 20
                    Treatment:  Ensure below has been obtained or started within the last 24-48 hours ...................... 22

                    Grade 3R.............................................................................................................................................. 23
                  Antibody Mediated Rejection Guideline................................................................................................. 24

                    Treatment (see dosing/treatment course details below) ................................................................... 24

                    Plasmapheresis procedure .................................................................................................................. 25
                    Medications ........................................................................................................................................ 25

                    Infection Prophylaxis ........................................................................................................................... 25
                    Monitoring post AMR Treatment: ...................................................................................................... 25

                    Donor specific antibodies Post Transplant ......................................................................................... 25
                  Approach to Rejection Algorithm ........................................................................................................... 26






               Updated May 17, 2018                                                                         4
   1   2   3   4   5   6   7   8   9