Page 18 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

 Daily CBC
o Isolation
 Patient needs a mask when exiting room
 No white coats, no dangling ties or badges.
 Contraindications to Thymoglobulin induction include:
o Overt sepsis in which case Simulect is used for induction instead
 First dose on day of transplant in OR (on visualization of donor heart) and
second dose on POD 4, unless able to start thymoglobulin prior to POD 4 due to
discontinuation of above contraindications
 < 35 kg administer 10 mg IV
 > 35 kg administer 20 mg IV
 Methylprednisolone
o 2 mg/kg/dose q 24 hrs x 2 doses (max dose 125 mg) started w/in 12 hrs of returning to
CVICU (POD#0 and #1)
o 1 mg/kg/dose q 24 hrs x 2 doses (POD #2 and #3)
o 0.5 mg/kg/dose q 24 hrs x 1 dose (continue 0.5mg/kg as needed for thymoglobulin
premedication)

 Mycophenolate Mofetil (Cellcept)
o Mycophenolate Mofetil (Cellcept)- IV to PO 1:1
2
2
 Starting dose of 300 mg/m BID , with a goal of 600 mg/m BID (max dose 1.5G)
 Consider decreasing dose for ANC <500
 Check dose is appropriate if WBC > 6

 Prograf (Tacrolimus)
o Prograf (Tacrolimus or FK506)
 0.1 to 0.2 mg/kg/day PO BID
 Goal Levels
 Post-operative – 2mths: 10-13 ng/ml, obtain levels daily until stable
 3 – 6 months: 8-11 ng/ml
 6-12 months: 6-9 ng/ml
 >12 months: 5-8 ng/ml
 Individual patient doses may vary based on patient clinical course

Maintenance Immunosuppression

“Standard” maintenance immunosuppression utilizes two agents – a calcineurin inhibitor and cell cycle
inhibitor. Most patients commence on Tacrolimus and mycophenolate mofetil (MMF) – both of which
are usually well tolerated. Other drugs may be substituted if there are significant side-effects, rejection
occurs despite adequate levels, cardiac allograft vasculopathy or renal impairment are a concern.

Updated November 9, 2017 18