Heart transplantation risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

There are no established risk factors that lead to cardiac transplantation. The prognosis of the patient post-transplantation depends on various donor and recipient factors.

Risk factors for poor outcome post-transplantation can be due to donor-specific characteristics, recipient-specific characteristics, and risk factors due to interactions between the donor and recipient.

Both the following factors are associated with an increased one-year mortality rate in the recipient.

• Advanced donor age ^[1]
• Prolonged ischemia time

• Use of total artificial heart as a bridge to transplant or a need for end-organ support in the form of mechanical ventilation or dialysis– associated with the greatest one-year mortality
• Best prognosis is seen if the indication for transplant is ischemic and nonischemic cardiomyopathy ^[2]

• Patients with a history of congenital heart disease, restrictive cardiomyopathy, and those undergoing retransplantation have a worse prognosis.
• Younger recipients (below age 55) have an advantage
• Pre-transplant serum creatinine and total bilirubin are linearly related to survival.

• Use of Amiodarone pretransplantation ^[3]
• Hypertension
• Hypercholesterolemia ^{[4] [5]}
• Diabetes
• Renal insufficiency
• Use of specific immunosuppressive regimen
• Elevated body mass index
• Tobacco use
• Obesity
• Early post-transplant complications
• Prior cardiac surgery
• Transplantation of a female heart into a male or female recipient ^[6]

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