New Guidelines for Heart Transplantation Are Set to Change Clinical Standards
ADDISON, Texas, April 21 /PRNewswire/ — The International Society for Heart and Lung Transplantation (ISHLT) today announces new guidelines to standardize care for heart transplant patients worldwide. The guidelines demonstrate a united effort to decrease complications, improve outcomes and increase patient survival rates among heart transplant recipients. The guidelines will be presented during today’s symposium The ISHLT Guidelines for Heart Transplant Recipients: Towards an International Consensus at the ISHLT 30th Annual Meeting and Scientific Sessions at the Hilton Chicago.
The ISHLT guidelines address all aspects of the surgery as well as extensive pre-operative care and long-term post-operative care. ISHLT paid special attention to the unique issues that arise within the pediatric heart transplant population. To ensure adequate representation, a pediatric heart transplant physician assisted with the development as a co-chair within each section of the guidelines.
“This was an unprecedented commitment by the ISHLT,” said Maria Rosa Costanzo, MD, a former Editor of the Journal of Heart and Lung Transplantation, who chaired the committee that prepared the guidelines. “We assembled experts from all areas of heart transplantation whose combined knowledge helped us create guidelines that represent the area’s most effective techniques and strategies.”
Since the first heart transplant procedure more than 40 years ago, patient care has been guided by the experience of individual clinicians and has varied from center to center. The collective effort of creating these guidelines drew upon the expertise of 40 writers from nine countries.
Many ISHLT recommendations are based on expert consensus, and not on randomized controlled clinical trials, and there are also gaps in evidence pertaining to many aspects of patient care. The ISHLT expects an increased awareness of these gaps in evidence will spur further research in many important areas of heart transplantation.
“There is great potential to further advance care of heart transplant recipients using these new standards of management,” said James K. Kirklin, MD, ISHLT President. “We expect these guidelines to help improve patients’ outcomes and raise awareness about the areas where more research is needed.”
An overview of the recommendations provided in the new guidelines will be presented during today’s symposium and the executive summary will be published later by the Journal of Heart and Lung Transplantation. The full document will be available as an ISHLT monograph in early 2011.
The Guidelines Document
The document consists of three parts: perioperative care, organ rejection and medication dosing, and long term post-operative care.
The first addresses the perioperative care of heart transplant recipients, including the surgical issues impacting early postoperative care, monitoring and treatment of early hemodynamic, metabolic and infectious issues, evaluation and treatment of allosensitization, evaluation and treatment of early coagulopathies, the organization of a multidisciplinary care team, management of ABO “incompatible” pediatric heart transplantation and the use of extracorporeal membrane oxygenation for the hemodynamic support of pediatric recipients.
The second section discusses the mechanisms, diagnosis and treatment of heart transplant rejection, the mechanisms of action, dosing, drug levels monitoring of immunosuppressive drugs, as well as their adverse effects and interactions with concomitantly used medications, reviews the major clinical trials and the immunosuppressive strategies to be used in special clinical situations.
Finally, the third section covers the myriad of clinical issues occurring long term after heart transplantation, including cardiac allograft vasculopathy, the chronic adverse effects of immunosuppression (neurotoxicity, renal insufficiency, hypertension, bone disease, diabetes and malignancy), reproductive health, exercise, psychological problems, return-to-work and operation of motor vehicles following transplant.
The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit organization dedicated to the advancement of the science and treatment of end-stage heart and lung diseases. Created in 1981, the Society now includes more than 2,200 members from 45-plus countries, representing a variety of disciplines involved in the management and treatment of end-stage heart and lung disease. For more information, visit www.ishlt.org.
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SOURCE International Society for Heart and Lung Transplantation