eMedicine Specialties > Transplantation > Surgery

Heart Transplantation: Workup

Author: Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: May 1, 2009

Workup

Laboratory Studies

  • Hepatitis panel: Provided no active antigenicity exists, these tests serve as a screen. Patients who are carriers of the disease or who have active disease are not considered candidates. Hepatitis C positivity remains controversial with respect to thoracic transplantation and is addressed on a center-to-center basis.
  • The patient must not be infected with HIV. HIV positivity remains a contraindication to transplantation.
  • Viral screening, including for Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus, is used to screen for past exposure and currently active disease.
    • Past exposure is indicative of a risk for reactivation. Institute appropriate prophylactic therapy after the transplant procedure.
    • Treat active disease before considering transplantation. Recipients whose test results are negative for CMV are generally administered cytomegalovirus immune globulin (CytoGam). Immunize patients whose test results are negative for other viral agents during the evaluation period.
  • Perform fungal serologies and tuberculosis (TB) skin testing, paying particular attention to environmental exposure. These studies are used to determine past exposure and to predict reactivation. Patients with positive TB skin test results are usually treated before being placed on the transplantation list.
  • If the prostate-specific antigen (PSA) study results are positive, the appropriate evaluation and therapy are instituted prior to completing the evaluation for transplantation.
  • Bilateral mammograms should reveal no abnormalities before listing for transplantation. If abnormalities are found, undertake appropriate referral for evaluation and therapy before proceeding further with the evaluation for transplantation.
  • Papanicolaou test (Pap smear) results should be negative prior to listing for transplantation. If positive, undertake appropriate referral for evaluation and therapy before proceeding with the evaluation for transplantation.
  • Perform CBC count with differential, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and complete chemistry profile (including liver panel, lipid profile, and urinalysis). Results of these tests should be essentially normal. Any abnormalities must be assessed before proceeding with the evaluation.
  • Blood type and screen, panel-reactive antibody (PRA), and tissue typing are used to determine the immunologic suitability of the patient for transplantation and donor matching.

Imaging Studies

  • In the case of cardiomyopathy, coronary arteriography is performed to determine if the cause of the cardiac dysfunction may be amenable to conventional therapies such as coronary artery angioplasty, coronary artery bypass surgery, or valve repair.
  • Echocardiography is used to determine cardiac ejection fraction and to monitor the cardiac function of patients on the transplantation waiting list. Ejection fractions of 25% or less are indicative of poor long-term survival rates.
  • Posteroanterior and lateral chest radiographs are used as a screening test for other thoracic pathologies that may preclude transplantation.

Other Tests

  • Pulmonary function tests are performed to assess overall pulmonary function. Severe untreatable pulmonary disease is a contraindication to the procedure.
  • Maximal venous oxygen consumption (MVO2) is used to assess overall cardiac function and is used as a predictor of the severity of congestive heart failure and survival. An MVO2 value of less than 15 is a poor prognostic indicator for 1-year survival in the patient awaiting cardiac transplantation.

Diagnostic Procedures

  • Endomyocardial biopsy of the potential candidate is not routinely performed. The procedure may be considered if a systemic process involving the heart is thought to be the cause of the cardiomyopathy.
  • Perform biopsies of appropriate areas if the patient exhibits symptoms of systemic disease. Biopsies are used to determine the extent and activity of the disease process. Systemic disease processes are a contraindication to cardiac transplantation.
  • Cardiopulmonary evaluation includes right- and left-heart catheterization to determine if the disease process is reversible or treatable by more conventional therapy. Careful evaluation of pulmonary vascular resistance is essential. Patients with fixed resistances above 4 Wood units are not candidates for the procedure.

More on Heart Transplantation

Overview: Heart Transplantation
Workup: Heart Transplantation
Treatment: Heart Transplantation
Follow-up: Heart Transplantation
Multimedia: Heart Transplantation
References
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References

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  2. Kramer BL, Massie BM, Topic N. Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study. Circulation. Apr 1983;67(4):807-16. [Medline].

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Further Reading

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Keywords

cardiac replacement, cardiac transplantation, cardiac allograft, cardiopulmonary bypass, cyclosporine, intra-aortic balloon pump, implantable assist devices, coronary artery angioplasty, coronary artery bypass surgery, CABG, valve repair, allografts, xenografts, end-stage congestive heart failure, CHF, ischemic cardiomyopathy, angina, pulmonary disease, malignant cardiac arrhythmias, coronary artery disease, CAD, congenital heart disease, CHD, cytomegalovirus, CMV, rejection, organ donors, organ donation

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Contributor Information and Disclosures

Author

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Richard Thurer, MD, B and Donald Carlin Professor of Thoracic Surgical Oncology, Miller School of Medicine, University of Miami
Richard Thurer, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Medical Association, American Thoracic Society, Florida Medical Association, Society of Surgical Oncology, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shreekanth V Karwande, MBBS, Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center
Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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