Months Post Transplantation 65Years

Fig. 11.2. Survival following heart transplantation as it relates to recipient age. From: Hosenpud JD et al. The registry of the International Society for Heart and Lung Transplantation: fifteenth official report. J Heart Lung Transplant 1998; 17:656-668. Reprinted by permission from Mosby Year-Book, Inc.

Patient Support Systems

Potential recipients must demonstrate an ability to comply with the complex medical regimens associated with posttransplant care. A support system of family and/or friends is extremely important in this regard. A thorough psychosocial evaluation is required to exclude the personality traits or interpersonal relationships, which will preclude successful care during the pre- and posttransplant time periods.

Severity and Progression of Patient Illness

A spectrum of illness exists among patients with end-stage heart failure. Heart failure may be acutely life threatening following an acute myocardial infarction, myocarditis, or failure to wean from cardiopulmonary bypass. Without inotropic infusions and/or support from an intraaortic balloon pump or mechanical ventricular assist device, such patients may die. Although acutely ill patients may survive to enter a more chronic condition, a decision must often be made during the acute phase whether or not the patient should be listed for transplantation.

Patients with more chronic heart failure may typically be managed as outpatients with strict attention to their medical regimen; this affords further stratification of the severity of their disease. Among patients with good control of their symptoms and satisfaction with their quality of life, continued medical therapy is indicated. Alternatively, repeated hospitalizations for heart failure indicate a poor prognosis and heart transplantation should be considered.

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