From the Guidelines
Orthotopic heart transplantation (OHTx) management should prioritize the bicaval technique, which is the most frequently used surgical technique, to minimize complications and improve patient outcomes. The bicaval technique involves separate superior and inferior vena cava anastomoses instead of the right atrial anastomosis, reducing the risk of post-operative thrombus formation and sinus node dysfunction 1. This technique is preferred over the standard biatrial technique, which can result in atrial geometry distortion and enlarged atria with a 'snowman' shape due to redundant atrial tissue.
Key considerations in OHTx management include:
- Surgical technique: The bicaval technique is the most frequently used and recommended approach 1.
- Post-operative care: Regular surveillance is mandatory, particularly in the first year after OHTx, to detect acute/chronic graft rejection and cardiac allograft vasculopathy (CAV) 1.
- Diagnostic approaches: Endomyocardial biopsy (EMB) and coronary angiography are the reference modalities for detecting acute GR and CAV, respectively, although they are invasive and carry non-negligible risks 1.
- Treatment strategies: Antibody-mediated rejection (AMR) treatment strategies may include antibody removal, inhibition of B-cell production, and T-cell depletion, with various centers employing different approaches 1.
In terms of morbidity, mortality, and quality of life, the bicaval technique is associated with improved outcomes compared to other surgical techniques. The use of this technique, combined with regular post-operative surveillance and appropriate diagnostic approaches, can help minimize complications and improve patient outcomes following OHTx 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
OHTx Management Overview
- Orthotopic heart transplantation (OHTx) is a common treatment for end-stage heart disease, with various immunosuppressive regimens used to prevent rejection 2, 3, 4, 5.
- The choice of immunosuppressive therapy can impact patient outcomes, including survival rates, rejection rates, and incidence of complications such as infection and malignancy 2, 4, 5.
Immunosuppressive Regimens
- Tacrolimus (TAC) is a commonly used calcineurin inhibitor in OHTx, often combined with mycophenolate mofetil (MMF) or cortisone 2.
- Sirolimus has also been used in combination with TAC, but has been associated with an increased incidence of mediastinitis and new-onset diabetes mellitus 4.
- Cyclosporine has been used in combination with everolimus or MMF, with varying degrees of success 5.
- Generic immunosuppressants, such as Myfenax Teva and Tacrolimus Sandoz, have been shown to be safe and effective in heart transplant patients 6.
Patient Outcomes
- Survival rates for OHTx patients have been reported to be high, with 1-year survival rates ranging from 81% to 97% 3, 4, 5.
- Rejection rates have also been reported, with some studies showing a higher incidence of rejection with certain immunosuppressive regimens 2, 4.
- Complications such as infection, malignancy, and graft vasculopathy have also been reported in OHTx patients 2, 3, 4.