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Table 11.2. Contraindications to cardiac transplantation

• Irreversible hepatic, renal or pulmonary dysfunction

• Severe peripheral vascular disease

• Cerebrovascular disease

• Insulin-requiring diabetes mellitus with end-organ damage

• Active infection

• Malignancy

• Inadequate psychosocial support systems

• Limited life expectancy from systemic disease

• Pulmonary vascular resistance > 6 Wood units

• Transpulmonary gradient > 15 mm Hg which will be created by a new heart. Specifically, pulmonary capillary wedge pressure is < 12-14 mm Hg with a systemic systolic arterial pressure > 100 mm Hg.

If under the conditions of such provocative testing the patient's systolic blood pressure falls below 90 mm Hg, and/or the PVR remains > 4 Wood units and/or transpulmonary gradient remains > 15 mm Hg, the patient's pulmonary circulation affords too much resistance to the donor heart's right ventricle. Heart transplantation should not be performed, and consideration should be given to heart-lung transplantation.

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