Transplant Cardiology

Question 1

Post Cardiac Transplant Survival

Answer 1

> 85% at 1 year
70% at 5 years
50% at 10 years

Question 2

Transplant candidates

Answer 2

Cardiopulmon VO2 <14ml/kg/min (<12 on BB) despite OMT (best way to check prognosis to determine candidate for transplant)
Resp exchange ratio >1.05 = max effort
If <50yo use <50% expected VO2

Question 3

Other tests for HF candidacy

Answer 3

Seattle HF test underestimates risk

6 MWT doesn’t work as well

Question 4

Triggers for Tx Eval

Answer 4

Frequent hospitalizations
Cardiorenal syndrome
poor fxn status on OMT

Question 5

Contraindications to Heart Tx

Answer 5

No family support
substance abuse
Pulm HTN
advanced age
obesity
poor renal fxn

Question 6

LVAD

Answer 6

1) Bridge to transplant
- severe decompensated HF despite ionotrope
- phenylephrine not ok (just inc’s SVR/afterload, no change to contractility and will dec CO)
- no sildenafil as will inc pulm flow and inc’d PCWP/left heart filling

Question 7

MC Cause of death

Answer 7

30 days - Primary graft failure (older donor age, ischemic time)
1 year - cellular rejection
Malignancy/vasculopathy - long term…
Hyperacute - minutes to hours - preformed donor specific antibodies in receipient
Acute cellular rejection - 2-3 months