Heart Transplant Contraindications — EECC MCQ

Correct answer: B — Absolute contraindications include: active malignancy with limited prognosis, irreversible severe organ dysfunction (hepatic cirrhosis, severe COPD), fixed elevated pulmonary vascular resistance (PVR >5 WU unresponsive to vasodilators), active systemic infection, and active substance abuse — age alone is not an absolute contraindication but outcomes decline above age 70

Heart transplant contraindications per the ESC HF and ISHLT Guidelines: ABSOLUTE: (1) active malignancy with limited prognosis (recent cancer must be disease-free for recommended period — varies by tumour type); (2) irreversible severe pulmonary, hepatic, or renal dysfunction not amenable to combined transplant; (3) fixed elevated PVR (>5 WU or TPG >15 mmHg unresponsive to vasodilator challenge — the donor RV will fail against high PVR); (4) active systemic infection; (5) active substance abuse or psychiatric illness preventing medication adherence. RELATIVE (assessed individually): (1) age >70 (carefully selected patients up to 75 may be considered); (2) BMI >35 (increased perioperative risk — weight loss pre-transplant); (3) diabetes with end-organ damage; (4) peripheral/cerebrovascular disease; (5) psychosocial factors. Post-transplant survival: ~85% at 1 year, ~50% at 12-15 years.

Reference: ESC (2023): HF Guidelines; ISHLT Heart Transplant