Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United States.Here we describe the barriers to adaptation of numerous...Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United States.Here we describe the barriers to adaptation of numerous“non-traditional”orthotopic heart transplant donor characteristics including donors with hepatitis C virus,those meeting criteria for donation after cardiac death,donors with coronavirus disease 19 infection,donors with the human immunodeficiency virus,and grafts with left ventricular systolic dysfunction.Our center’s objective was to increase our transplant volume by expanding our donor pool from“traditional”donors to these“non-traditional”donors.We detail how medical advances such as certain laboratory studies,pharmacologic interventions,and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.展开更多
Cardiovascular diseases(CVD)form a principal consideration in patients with end-stage liver disease(ESLD)undergoing evaluation for liver transplant(LT)with prognostic implications in the peri-and post-transplant perio...Cardiovascular diseases(CVD)form a principal consideration in patients with end-stage liver disease(ESLD)undergoing evaluation for liver transplant(LT)with prognostic implications in the peri-and post-transplant periods.As the predominant etiology of ESLD continues to evolve,addressing CVD in these patients has become increasingly relevant.Likewise,as the number of LTs increase by the year,the proportion of older adults on the waiting list with competing comorbidities increase,and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles.The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri-and post-transplant periods.The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability.This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization.We hope that this will reinforce the importance of cardiovascular optimization prior to LT,prevent futile LT in those with advanced CVD beyond the stage of optimization,and thereby use the finite resources prudently.展开更多
文摘Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United States.Here we describe the barriers to adaptation of numerous“non-traditional”orthotopic heart transplant donor characteristics including donors with hepatitis C virus,those meeting criteria for donation after cardiac death,donors with coronavirus disease 19 infection,donors with the human immunodeficiency virus,and grafts with left ventricular systolic dysfunction.Our center’s objective was to increase our transplant volume by expanding our donor pool from“traditional”donors to these“non-traditional”donors.We detail how medical advances such as certain laboratory studies,pharmacologic interventions,and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.
文摘Cardiovascular diseases(CVD)form a principal consideration in patients with end-stage liver disease(ESLD)undergoing evaluation for liver transplant(LT)with prognostic implications in the peri-and post-transplant periods.As the predominant etiology of ESLD continues to evolve,addressing CVD in these patients has become increasingly relevant.Likewise,as the number of LTs increase by the year,the proportion of older adults on the waiting list with competing comorbidities increase,and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles.The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri-and post-transplant periods.The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability.This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization.We hope that this will reinforce the importance of cardiovascular optimization prior to LT,prevent futile LT in those with advanced CVD beyond the stage of optimization,and thereby use the finite resources prudently.
