Page 4 - Heart Transplant Guidelines
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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

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

                  Pre-Transplant Immunosuppression Orders ........................................................................................... 16
                  Post-Transplant Immunosuppression Guidelines ................................................................................... 16

                  Maintenance Immunosuppression ......................................................................................................... 18
                    Mycophenolate Mofetil (Cellcept) ...................................................................................................... 18

                    Prograf (Tacrolimus)............................................................................................................................ 18
                    Sirolimus (Rapamycin) ........................................................................................................................ 18

                    Azathioprine (Imuran) ......................................................................................................................... 18
                    Cyclosporine ........................................................................................................................................ 18

               Desensitization Guideline ........................................................................................................................... 19

                  Prerequisites ........................................................................................................................................... 19
                  Desensitization Regime without Plasmapheresis ................................................................................... 19

                  Desensitization Regime with Plasmapheresis ......................................................................................... 19
               Rejection ..................................................................................................................................................... 21

                  Surveillance (Protocol) Biopsies .............................................................................................................. 21
                  Acute Cardiac Cellular Rejection ............................................................................................................. 21

                  2005 ISHLT Cellular Rejection Grading Criteria ....................................................................................... 22

                  Treatment: .............................................................................................................................................. 23
                  Antibody Mediated Rejection Guideline................................................................................................. 24

                    Treatment (see dosing/treatment course details below) ................................................................... 24
                    Plasmapheresis procedure .................................................................................................................. 25

                    Medications ........................................................................................................................................ 25
                    Infection Prophylaxis ........................................................................................................................... 25






               Updated November 13, 2018                                                                    4
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