Page 4 - Heart Transplant Guidelines

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
Prednisolone ....................................................................................................................................... 18

Sirolimus (Rapamycin) ........................................................................................................................ 18
Azathioprine (Imuran) ......................................................................................................................... 18

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

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

Desensitization Regime without Plasmapheresis ................................................................................... 19
Desensitization Regime with Plasmapheresis ......................................................................................... 20

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

Updated December 14, 2018 4