100 QUESTIONS IN CARDIOLOGY

33 New York Heart Association class III or IV

44 Non-transplant cardiac surgery considered unfeasible

55 Heart failure resulting from one of the following:

• Ischaemic heart disease


• Cardiomyopathy


• Valvular heart disease


• Congenital heart disease.

Lung transplantation – indications

11 Severe respiratory failure, despite maximal medical therapy

22 Severely impaired quality of life

33 Patient positively wants a transplant.

Only patients who have deteriorating chronic respiratory

failure should be accepted on to the transplant waiting list. In

practice, the forced expiratory volume in one second is usually

less than 30% of the predicted value.

Careful psychological assessment is necessary to exclude

patients with intractable psychosocial instability that may

interfere with their ability to cope with the operation and to

comply with the strict post operative follow up and immuno-

suppressive regimes. In most centres, the upper age limit is 60

years for cardiac transplantation and for single lung transplantation

and 50 years for heart-lung and bilateral lung transplantation.

Contraindications for cardiac and lung transplantation

11 Psychosocial instability and poor compliance

22 Infection with hepatitis B or C virus or with human immuno-

deficiency virus

33 Active mycobacterial or aspergillus infection

44 Active malignancy (patient must be in complete remission for

more than five years after treatment)

55 Active peptic ulceration

66 Severe osteoporosis

77 Other end-organ failure not amenable to transplantation e.g.

hepatic failure or renal failure (creatinine clearance <50mls/min).

Incremental risk factors for pulmonary transplantation include

previous thoracic surgery and pleurodesis and patients are not

accepted on to the waiting list who are on long term prednisolone