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Cardiac Transplant Assessment — EECC MCQ

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HardHeart FailureCardiac Transplant AssessmentEECC

A 60-year-old man with HFrEF (LVEF 25%) presents with recurrent decompensations despite maximal GDMT. His NT-proBNP is persistently >5,000 pg/mL. He has a good performance status and no significant comorbidities. His estimated 1-year mortality on the SHFM (Seattle Heart Failure Model) is >20%. According to ESC guidelines, when should cardiac transplant be considered?

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Correct answer: B — When estimated 1-year survival with medical therapy is <80% despite optimal management, and the patient has no absolute contraindications to transplant

The ESC HF Guidelines recommend cardiac transplant assessment for patients with advanced HF (NYHA III-IV) despite optimal GDMT when estimated 1-year survival is <80% and the patient has no absolute contraindications. Validated tools (SHFM, HFSS) can estimate survival. Absolute contraindications include: active malignancy, irreversible pulmonary hypertension (PVR >5 WU unresponsive to vasodilators), active systemic infection, severe irreversible renal or hepatic failure, active substance abuse, and severe psychiatric illness with poor compliance. Age alone is not an absolute contraindication, though outcomes decline above 70 years. LVAD may serve as a bridge to transplant, bridge to decision, or destination therapy.

Reference: ESC (2023): Focused Update on Heart Failure; ISHLT Heart Transplant Guidelines