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Canadian Journal of Cardiology

Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care

      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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