From the Research
Heart transplantation in the UK is indicated for patients with end-stage heart failure who have exhausted all other medical and surgical treatment options, as stated in the most recent guidelines 1. According to these guidelines, candidates should have severe heart failure (typically NYHA class III or IV) despite optimal medical therapy, including ACE inhibitors/ARBs, beta-blockers, aldosterone antagonists, and diuretics at maximum tolerated doses. Some key points to consider when evaluating a patient for heart transplantation include:
- Specific indications, such as a left ventricular ejection fraction below 25%, VO2 max less than 12-14 ml/kg/min on cardiopulmonary exercise testing, or significant functional limitation with a 6-minute walk distance under 300 meters 2.
- Patients should have a life expectancy of less than 2 years without transplantation but otherwise have good potential for rehabilitation.
- Common underlying conditions include dilated cardiomyopathy, ischemic heart disease, congenital heart disease, and valvular heart disease that cannot be managed with conventional surgery.
- Contraindications include active infection, recent malignancy, severe pulmonary hypertension (pulmonary vascular resistance >5 Wood units), significant renal or hepatic dysfunction, recent stroke, active substance abuse, or poor compliance with medical therapy 3.
- Patients must also have adequate psychosocial support for the complex post-transplant care regimen. The decision for transplantation is made by a multidisciplinary team after thorough evaluation of the patient's cardiac status, comorbidities, and potential for successful outcomes, with the goal of improving survival and quality of life, as demonstrated by studies comparing heart transplant recipients to patients with advanced heart failure 4.