Page 4 - Heart Transplant Protocol
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Heart Function Service: Heart Transplant Protocols



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

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

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

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

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

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

               Rejection ..................................................................................................................................................... 19
                  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 Protocol .................................................................................................. 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
               Cardiac Allograft Vasculopathy (CAV) Surveillance and Intervention Protocol .......................................... 27






               Updated February 27, 2018                                                                    4
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