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Recipient selection and management before cardiac transplantation
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Cardiac transplantation effectively treats end-stage congestive heart failure. Careful recipient selection is crucial due to donor scarcity, prioritizing patients with limited survival and quality of life for long-term benefit.
Area of Science:
- Cardiology
- Transplant Surgery
Background:
- Congestive heart failure (CHF) is a leading cause of mortality.
- Cardiac transplantation is an established therapy for end-stage CHF.
- Limited donor organ availability poses a significant challenge.
Purpose of the Study:
- To outline recipient selection criteria for cardiac transplantation.
- To emphasize the importance of multidisciplinary assessment.
- To discuss evolving strategies in light of donor organ scarcity.
Main Methods:
- Multidisciplinary team evaluation (transplant physicians and surgeons).
- Assessment of cardiac dysfunction severity and patient prognosis.
- Risk stratification for mortality.
Main Results:
- Candidates are patients with severely limited survival and quality of life without transplantation.
- Careful screening identifies patients likely to achieve long-term benefit.
- Evolving criteria address extended waiting times and high mortality.
Conclusions:
- Recipient selection is critical for optimizing outcomes in cardiac transplantation.
- Strategies must adapt to donor organ shortages and patient survival rates.
- Alternative therapies should be considered when appropriate.
Abstract:
Cardiac transplantation is a proven, effective therapy for selected patients with end-stage congestive heart failure. Recipient selection is performed by a multidisciplinary team consisting of transplant physicians and surgeons. Clinicians responsible for patient assessment must establish the severity of cardiac dysfunction, formulate a prognosis, and stratify patients according to risk for mortality. Patients whose survival and quality of life are most limited without cardiac transplantation are candidates for therapy. The scarcity of organ donors makes careful screening of potential recipients necessary to identify those individuals most likely to obtain a long-term benefit. Recipient selection criteria and management strategies are evolving because of extended waiting times and high mortality caused by the lack of sufficient numbers of donors. Alternative therapies should be applied wherever possible.