ISHLT Issues New Guidelines for Heart Transplantation Candidacy

After 10 years, the International Society for Heart and Lung Transplantation have released updated guidelines to assist doctors identify which patients may be ideal candidates for heart transplantation. download (2)

Updated guidelines are presented in The Journal of Heart and Lung Transplantation and these are an outcome of an alliance between the International Society for Heart and Lung Transplantation (ISHLT) Heart Failure and Transplantation, Pediatric and Infectious Disease Councils.

Lead by Dr. Mandeep R. Mehra, the modified guidelines for heart transplantation candidacy deal with some of the problems that have come to light since such guidelines were initially published in 2006.

One major problem has been heart transplantation eligibility for sufferers with specific medical problems; the 2006 guidelines mentioned that sufferers with specific conditions shouldn’t be considered for the process.

However, dependent on latest scientific proof, the ISHLT now point out that sufferers with human immunodeficiency virus (HIV), tuberculosis, Chagas disease or hepatitis can now be considered appropriate transplant candidates, provided they fulfill other requirements.

In addition, the 2006 recommendations mentioned that for heart failure individuals who are overweight, a body mass index of 35 or below must be obtained prior to they can be considered for a heart transplant.However, the modified guidelines now state that physicians must make sure such individuals reach a BMI of 30 or below, dependent on new proof showing that more sufferers are likely to be eligible for heart transplantation if they achieve this objective.

New recommendations ‘deal with most debatable issues of our times’
One more significant change to the 2006 guidelines includes the Heart Failure Survival Score (HFSS) – a system that is used to approximate all-cause mortality for individuals with heart failure. The HFSS is applied to judge a sufferer’s eligibility for heart transplantation.

However, latest research have raised issues about the accuracy of the HFSS. As a result, the modified guidelines state that listing sufferers for heart transplantation based solely on HFSS requirements should only take place if a sufferer’s prognosis is not clear.

The ISHLT have also modified recommendations for the use of right heart catheterization (RHC) – a examination that identifies how good the heart is pumping. The Society now suggest that all adult heart transplant people go through RHC testing prior to being listed for the process, and such sufferers should be examined consistently up till the date of transplantation.

For heart failure sufferers with possibly reversible or curable co-existing problems – like renal failure, cancer or obesity – and those who have pharmacologically permanent pulmonary hypertension or who use tobacco, the ISHLT now suggest that mechanical circulatory support be prefered to identify heart transplantation candidacy, with re-evaluation suggested prior to a decision is taken.

The modified guidelines also take sufferers’ social support into account, observing that for people who are not likely to comply with out-patient care requirements, heart transplantation may be viewed as a major risk.

The ISHLT also suggest against heart transplantation for sufferers with severe cognitive problems, noting that this may effect their potential to understand the process, stick to medical suggestions or engage in self-injury; the advantages of heart transplantation have not been identified in such individuals.

Leaving comments on the updated recommendations, Dr. Mehra states that:
“There are a lot of controversial problems in the recommendations that we have tackled head on, such as heart transplantation in previously rejected situations (HIV, hepatitis amyloidosis, specific congenital heart conditions) that we now allow or suggest more lenient listing.

The 2006 guidelines were especially significant in that we recommended against an age limit for transplantation or time dependency for sufferers with formerly healed cancers (e.g. waiting around a min. of 5 years for freedom from cancers). The new recommendations not only update a number of of these earlier issues, but also deal with the most debatable issues of our times.”