Cardiology - Heart Transplant Flashcards
Indications for Transplantation?
1) Refractory Class III - IV PLUS:
- despite maximum medical therapy
- needing mechanical support
- cardiogenic shock
2) VO2 max <14ml/kg/min + anaerobic metabolism
3) severe intractable angina despite optimum interventions
4) Recurrent refractory ventricular arrythmias with frequent recurrent AICD discharges
Immunosuppression regime in heart transplant?
Calcineurin inhibitor (tacrolimus / cyclosporin)
Inhibitor of T cell proliferation (azathioprine / mycophenolate mofetil / sirolimus / everolimus)
Glucocorticoid
What additional induction medication may be used?
Monoclonal antibody to block IL2R
basilixumab
Rate of rejection post transplant?
20% in first year
Leading cause of early mortality
How to diagnose rejection post transplant?
Endomyocardial biopsy
Risk factors for rejection post transplant?
Female
Young
Signs of rejection post transplant?
Heart failure
Atrial arrythmias
Usually no signs
Post transplant survival rates
10 yr survival 50%
30% live >20 years
What altered physiology is seen in a transplanted heart?
No vagal innervation
- HR usually 90 - 110bpm
- MARKED response to adenosine and it can cause PROLONGED AV block!
Denervated heart –> NO anginal symptoms
Risk factors for allograft coronary artery disease?
Dyslipidaemia
Diabetes
CMV
Difference between non-transplant and transplant coronary artery disease
Non-Transplant: proximal, localised, eccentric and calcified
Transplant: distal, diffuse, concentric and non-calcified
Role of statin use in transplanted heart?
Associated with reduced allograft coronary artery disease
What other drugs can prevent coronary artery disease in a transplanted heart?
Mycophenolate mofetil and mTOR inhibtiors (sirolimus and everolimus) are associated with:
SHORT TERM lower incidence and extent of coronary intimal thickening
What are the most common malignancies post transplant?
Lymphoproliferative (EBV associated)
Cutaneous (BCC and SqCC)
