Cardiac transplantation

Question 1

Indications for cardiac transplant

Answer 1

• Cardiogenic shock requiring continous ionotropes/circ support
• persistent NYHF class 4 refract to medications
• intractable angina refract to medication/PCI
• intractable arythmias
• certain cardiac amyloids
• congenital heart disease -nyhf 4, cyanosis. pulm htn(pre pulm vasc resistance)

Question 2

Best Prognostic indicator for consideration cardiac transplant

Answer 2

Peak V02 (most important predictor)

Question 3

Contraindications for cardiac transplant

Answer 3

1) Systemic illness with life expec less than 2 years (even with transplant)
2) Active substance abuse
3) Non compliance with medications
4) Pulmonary vascular resistance
5) Severe symptomatic cvd
6) Multisystem disease with severe extracardiac involvement

Question 4

Cause of death Post cardiac transplant first 30 days

Answer 4

Most common primary graft failure
due to
1) donor related factors -donor myocardial dysfunction
2) transplant related factors- air embolism, delayed
reperfusion injury

Question 5

Cause of death after one week cardiac transplant

Answer 5

acute rejection OR cardiac allograft vasculopathy

Question 6

Cause of death 6mths to one yr post cardiac transplant

Answer 6

opportunistic infection - multiple organisms

Question 7

Most common cause of death 5 years post transplant

Answer 7

Malignancy - Lymphoma and solid organ

Question 8

When combined heart lung transplant

Answer 8

Eisenmenger

Idiopathic Pulmunary hypertension- causing right heart failure