Heart Transplant Centers of Excellence – Core Requirements
Heart Transplant Centers of Excellence – Core Requirements
Source: Medical News – September 2025
Based on: International Society for Heart and Lung Transplantation (ISHLT) – Guidelines for the Care of Heart Transplant Candidates
Published: August 8, 2024
Keynotes
1. Referral & Timing
• Patients with advanced HF (Heart Failure) should be referred early for transplant evaluation.
• Indicators: repeated hospitalizations, intolerance to GDMT (Guideline-Directed Medical Therapy), persistent symptoms, low cardiac index.
2. Multidisciplinary Transplant Team (MDT)
• Core members: HF cardiologist, transplant surgeon, infectious disease specialist, nephrologist, hepatologist, psychologist, pharmacist, dietitian, social worker, rehabilitation specialist.
• Regular joint meetings for listing decisions and post-transplant care.
3. Pre-Transplant Optimization
• Stabilization with GDMT, device therapy (ICD/CRT), and temporary or durable mechanical circulatory support (MCS, e.g., LVAD).
• Correction of comorbidities, vaccinations, nutritional support, psychosocial readiness.
4. Waiting List Management
• Risk stratification of candidates (high, intermediate, stable).
• Use of immunological testing (crossmatch, panel reactive antibodies).
• Infection prevention and immunization updates while waiting.
5. Surgical & Immediate Post-Operative Care
• Early graft assessment: simple bedside exam, ECG, and focused echocardiography to check graft function. If the patient is unstable or cardiac output is low, this should trigger urgent evaluation.
• ICU monitoring: continuous hemodynamic measurements — arterial line pressure and, when indicated, central venous or pulmonary artery catheter readings — to ensure adequate graft perfusion and preserve organ function.
• Infection prophylaxis: standard antibiotics given around surgery; antiviral therapy guided by CMV (Cytomegalovirus) status; Pneumocystis (PJP) prophylaxis; antifungal drugs only in high-risk cases.
• Glycemic and renal protection: strict blood sugar control, avoid nephrotoxic drugs, and maintain proper fluid balance to protect kidney function.
Post-Transplant Follow-Up
• Rejection surveillance: endomyocardial biopsies every 1–2 weeks during the first 3 months, then monthly until 6 months, then every 2–3 months up to one year, and less often thereafter. Non-invasive methods (blood gene-expression profiling or imaging such as echo/MRI) may be used when appropriate.
• Immunosuppression long-term: lifelong therapy with combinations such as calcineurin inhibitors, antiproliferative agents, and steroids. Doses adjusted to balance rejection prevention with infection/toxicity risks. Regular monitoring of blood drug levels; minimize steroids when feasible.
• Infection & malignancy surveillance:
• Vaccinations kept up to date.
• Ongoing CMV monitoring with PCR tests and prophylaxis as needed.
• Screening for skin and organ cancers.
• Watch for PTLD (post-transplant lymphoproliferative disorder) — signs include fever, weight loss, enlarged nodes, or GI symptoms; requires early recognition and therapy adjustment.
• Comorbidity management: ongoing control of blood pressure, diabetes, lipids, renal function, and bone health.
Outcomes & Registry
• Centers must document graft survival, rejection episodes, major infections, rehospitalizations, and patient quality of life in a local or national transplant registry.
• These data provide transparency, allow benchmarking, and ensure continuous improvement in transplant care.
7. Quality & Outcomes
• Registry reporting is essential: graft survival, rejection episodes, infection rates, rehospitalization, quality of life.
• Data to be entered in electronic medical records or national transplant registries.
Conclusion & Practical Implications
Heart Transplant CoE require early referral, comprehensive MDT care, structured waiting list management, standardized surgery and follow-up protocols, and continuous registry-based outcome monitoring. Implementing these pillars allows alignment with ISHLT standards while adapting to local health system capacities.
