Abstract
Significant practice-changing developments have occurred in the care of heart transplantation
candidates and recipients over the past decade. This Canadian Cardiovascular Society/Canadian
Cardiac Transplant Network Position Statement provides evidence-based, expert panel
recommendations with values and preferences, and practical tips on: (1) patient selection
criteria; (2) selected patient populations; and (3) post transplantation surveillance.
The recommendations were developed through systematic review of the literature and
using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
system. The evolving areas of importance addressed include transplant recipient age,
frailty assessment, pulmonary hypertension evaluation, cannabis use, combined heart
and other solid organ transplantation, adult congenital heart disease, cardiac amyloidosis,
high sensitization, and post-transplantation management of antibodies to human leukocyte
antigen, rejection, cardiac allograft vasculopathy, and long-term noncardiac care.
Attention is also given to Canadian-specific management strategies including the prioritization
of highly sensitized transplant candidates (status 4S) and heart organ allocation
algorithms. The focus topics in this position statement highlight the increased complexity
of patients who undergo evaluation for heart transplantation as well as improved patient
selection, and advances in post-transplantation management and surveillance that have
led to better long-term outcomes for heart transplant recipients.
Résumé
Les pratiques relatives aux soins prodigués aux candidats à une transplantation cardiaque
et aux receveurs d’un nouveau cœur ont beaucoup évolué depuis dix ans. Le présent
énoncé de position conjoint de la Société canadienne de cardiologie et du Canadian Cardiac Transplant Network fait état des recommandations d’un groupe d’experts fondées sur des données probantes,
et comprend des valeurs et des préférences ainsi que des conseils pratiques concernant
les critères de sélection des patients, des populations de patients particulières
et la surveillance post-transplantation. Ces recommandations ont été formulées à la
suite d’une revue exhaustive de la littérature et au moyen du système GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Les domaines d’importance en évolution abordés comprennent l’âge du receveur, l’évaluation
de sa fragilité, l’évaluation de l’hypertension pulmonaire, l’usage de cannabis, la
transplantation cardiaque jumelée à la greffe d’un autre organe solide, la cardiopathie
congénitale chez l’adulte, l’amylose cardiaque, la sensibilisation élevée ainsi que
la prise en charge des anticorps à l’antigène leucocytaire humain, du rejet du greffon,
de l’artériosclérose accélérée du greffon cardiaque et des soins non cardiaques de
longue durée après la transplantation. Il est aussi question des stratégies de prise
en charge propres au Canada, notamment l’établissement de la priorité des candidats
à la transplantation hautement sensibilisés (statut 4S) et les algorithmes d’attribution
des organes. Les thèmes principaux de cet énoncé de position font ressortir la complexité
croissante des cas des patients qui subissent une évaluation en vue d’une transplantation
cardiaque ainsi que l’amélioration des critères de sélection des patients et les avancées
dans la prise en charge et la surveillance après la transplantation, qui permettent
aux receveurs d’une greffe cardiaque d’obtenir de meilleurs résultats à long terme.
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Article Info
Publication History
Accepted:
December 17,
2019
Received:
November 27,
2019
Footnotes
The disclosure information of the authors and reviewers is available from the CCS on their guidelines library at www.ccs.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
