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Candidate selection for heart transplantation

L W Miller1

  • 1Heart Failure/Heart Transplant Program, Saint Louis University Health Sciences Center, MO 63110, USA.

Cardiology Clinics
|February 1, 1995
PubMed
Summary
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Heart transplant candidate selection needs clearer criteria. Peak oxygen consumption (VO2) testing can identify patients who will most benefit from heart transplantation, optimizing donor organ allocation.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Pulmonary Function Testing

Background:

  • The demand for heart transplantation exceeds donor availability, necessitating refined patient selection criteria.
  • Current referral rates for heart transplantation are outpacing donor organ supply.
  • Developing uniform criteria for heart transplant candidate selection is crucial.

Purpose of the Study:

  • To establish objective criteria for evaluating heart transplant candidacy.
  • To utilize cardiopulmonary exercise testing, specifically peak oxygen consumption (VO2), to guide transplant listing decisions.
  • To optimize the allocation of donor hearts to patients with the greatest potential for survival benefit.

Main Methods:

  • Assessed patients using maximal treadmill testing to determine peak oxygen consumption (VO2) under maximal medical therapy.

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  • Defined thresholds for VO2 to guide heart transplant candidacy: <50% predicted VO2 for strong consideration, >60% predicted VO2 for probable non-candidacy without other risk factors.
  • Considered other significant risk factors, including refractory ventricular arrhythmias and unrevascularizable ischemia.

    • Main Results:

    • Peak oxygen consumption (VO2) via treadmill testing demonstrates significant cardiac functional impairment.
    • Patients with peak VO2 <50% of predicted warrant serious consideration for heart transplantation.
    • Patients with peak VO2 >60% of predicted are unlikely candidates unless other severe risk factors are present.

    Conclusions:

    • Implementing VO2 testing provides objective criteria for heart transplant candidate selection.
    • These guidelines can reduce the waiting list and expedite transplants for eligible patients.
    • Objective functional assessment improves the efficiency and effectiveness of heart transplant programs.