Page 4 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Preface .......................................................................................................................................................... 3
Transplant Evaluation ................................................................................................................................... 8

Role of Each Consult Service during Pre-Transplant Evaluation ............................................................... 8
Indications and Contraindications to Transplant & Re-transplant ......................................................... 10

Donor Offers ........................................................................................................................................... 11
ABO-Incompatible Heart Transplantation .............................................................................................. 11

HLA-Incompatible Heart Transplantation ............................................................................................... 15

Desensitization Protocol ..................................................................................................................... 15
Protocol for Patients with a Positive Retrospective Cross-Match ...................................................... 16

Immunosupression ..................................................................................................................................... 17
Pre-Transplant Immunosuppression Orders ........................................................................................... 17

Post-Transplant Immunosuppression Protocols ..................................................................................... 17
Maintenance Immunosuppression ......................................................................................................... 18

Mycophenolate Mofetil (Cellcept) ...................................................................................................... 19
Prograf (Tacrolimus)............................................................................................................................ 19

Sirolimus (Rapamycin) ........................................................................................................................ 19
Azathioprine (Imuran) ......................................................................................................................... 19

Cyclosporine ........................................................................................................................................ 19

Rejection ..................................................................................................................................................... 19
Acute Cardiac Cellular Rejection ............................................................................................................. 20

Treatment: Ensure below has been obtained or started within the last 24-48 hours ...................... 22
Grade 3R.............................................................................................................................................. 23

Antibody Mediated Rejection Protocol .................................................................................................. 24
Treatment (see dosing/treatment course details below) ................................................................... 24

Plasmapheresis procedure .................................................................................................................. 25

Medications ........................................................................................................................................ 25
Infection Prophylaxis ........................................................................................................................... 25

Monitoring post AMR Treatment: ...................................................................................................... 25
Donor specific antibodies Post Transplant ......................................................................................... 25

Approach to Rejection Algorithm ........................................................................................................... 26
Cardiac Allograft Vasculopathy (CAV) Surveillance and Intervention Protocol .......................................... 27

Updated November 9, 2017 4