Selecting candidates for cardiac transplantation. How to assess exclusion criteria and predict who will benefit

Area of Science:

• Cardiology
• Transplantation Medicine

Background:

• Advanced heart failure significantly impacts patient prognosis.
• Medical therapy is the first line of treatment for heart failure.
• Cardiac transplantation is a life-saving option for end-stage heart failure.

Purpose of the Study:

• To outline the primary and secondary indications for cardiac transplantation.
• To highlight the challenges in determining refractory heart failure for transplant candidacy.

Main Methods:

• Review of established criteria for cardiac transplantation.
• Analysis of patient conditions and treatment responses.

Main Results:

• The main indication for cardiac transplantation is advanced heart failure refractory to medical therapy, particularly in patients with coronary artery disease or dilated cardiomyopathy.
• Other indications include advanced valvular/congenital heart disease and rare cardiomyopathies, inflammatory conditions, or cardiac tumors.
• Assessing true refractoriness to medical therapy is challenging and cannot rely solely on ejection fraction or acute clinical status.

Conclusions:

• Cardiac transplantation is reserved for end-stage heart failure unresponsive to optimal medical management.
• Careful patient selection is crucial, requiring comprehensive evaluation beyond basic clinical or functional metrics.