List of Abbreviations
MCS - mechanical circulatory support device
AH - arterial hypertension
BP — blood pressure
ACE - angiotensin-converting enzyme
Anti-HLA - antibodies to human leukocyte antigens
CADPS - coronary artery disease of the transplanted heart
BB - beta-blocker
ARB - angiotensin II receptor blockers
VA ECMO - venoarterial extracorporeal membrane oxygenation
HIV - human immunodeficiency virus
D - diuretics
PCWP - pulmonary capillary wedge pressure
RAP - right atrial pressure
LTMCS - long-term mechanical circulatory support
BMI – body mass index
EDV - end-diastolic volume
ESV - end-systolic volume
CT — computed tomography
LV — left ventricle
PVR - pulmonary vascular resistance
MRI — magnetic resonance imaging
ICU - intensive care unit
FEV1 - forced expiratory volume in 1 second
RNA - ribonucleic acid
SBP - systolic blood pressure
DM - diabetes mellitus
sPAP - systolic pulmonary artery pressure
CI - cardiac index
GFR – glomerular filtration rate
TPG - transpulmonary gradient
HT - heart transplantation
OHT - orthotopic heart transplantation
EF - ejection fraction
LVEF – left ventricular ejection fraction
FC – functional class
CHF – chronic heart failure
HFrEF - heart failure with reduced ejection fraction
HFmrEF - heart failure with mildly reduced ejection fraction
HFpEF - heart failure with preserved ejection fraction
CNS - central nervous system
HR – heart rate
EchoCG – echocardiography
ESC - European Society of Cardiology
ISHLT - International Society for Heart and Lung Transplantation
HLA - human leukocyte antigen
NYHA - New York Heart Association
Terms and Definitions
Heart transplantation is a cardiac surgical procedure in which a recipient's pathologically altered heart is replaced with a satisfactorily functioning donor heart.
Heart transplant rejection is a pathological process in which the recipient's immune system recognizes the cardiac allograft as foreign and activates a humoral and/or cellular inflammatory response, which can lead to pronounced graft dysfunction.
Mechanical circulatory support is a surgical treatment method for severe heart failure in which central hemodynamics is supported by the operation of an implantable or external mechanical circulatory support device based on an electric pump.
Heart transplant recipient is a patient who has undergone heart transplantation.
Potential heart recipient is a patient with indications for heart transplantation who has been placed on the waiting list.
Heart failure is a syndrome characterized by a set of symptoms caused by the inability of the cardiovascular system to provide the patient's tissues and organs with an adequate blood supply. In primary heart failure, the cause of the pathological condition is impaired myocardial function or structural changes in the heart.
1. Brief information on the disease or condition
Orthotopic heart transplantation (OHT) is the gold standard for the treatment of end-stage heart failure (HF), significantly improving prognosis and quality of life [1,2,3].
Factors influencing mortality and patient survival during the first year after OHT include perioperative factors (donor age and weight, graft ischemia time, retransplantation, recipient age, baseline severity of condition and need for mechanical circulatory support in the preoperative and perioperative periods, postoperative pulmonary hypertension, renal failure, number of transplantations performed by the transplant center), as well as infectious complications and graft rejection. Heart transplant recipients receive medical care and undergo scheduled examinations at specialized transplant centers, but remain under the supervision of general practitioners (primary care physicians) and cardiologists at their place of residence.
These guidelines are intended for cardiovascular surgeons (transplant surgeons), cardiologists, and general practitioners; they comply with and do not contradict the main provisions of the guidelines of the International Society for Heart and Lung Transplantation, as well as the guidelines of the European Society of Cardiology and the Russian Society of Cardiology.
1.1 Definition of the disease or condition
A description of the medical care technology is presented, involving examinations to select the management strategy for patients with end-stage heart failure, determine indications for heart transplantation or mechanical circulatory support device implantation, assess perioperative risk and waitlist priority status for inclusion on the heart transplant waiting list, stabilize the clinical condition, and evaluate the possibility of patient recovery/rehabilitation after orthotopic heart transplantation, as well as the management of patients following heart transplantation.
Age category: adults, children;
Gender: any;
Phase: compensation/decompensation, acute;
Stage: 1 or 2;
Complications: Heart failure functional classes III-IV according to the New York Heart Association (NYHA) classification;
Type of medical care: high-tech medical care, compulsory medical insurance;
Conditions for medical care delivery: inpatient;
Form of medical care delivery: elective, urgent, emergency.
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
Indications for heart transplantation and/or mechanical circulatory support device implantation include heart diseases of various etiologies leading to severe heart failure refractory to other medical and surgical treatments.
1.3 Epidemiology of the Disease or Condition
According to Russian epidemiological studies, the prevalence of chronic heart failure in the Russian Federation has increased from 6.1% to 8.2% over the last 20 years [482].
Currently, despite advances in the pharmacotherapy of cardiovascular diseases, orthotopic heart transplantation (OHT) is the universally recognized "gold" standard for the treatment of end-stage HF, significantly improving prognosis and quality of life [1,2,3]. Annually, more than 4,000 heart transplants are performed worldwide, with the vast majority of interventions taking place in Europe and North America [4,7]. Against the background of an increasing total number of heart transplants in our country, there is a significant reduction in perioperative mortality and an improvement in long-term survival [8].
1.4 Features of Coding the Disease or Condition
These guidelines apply to patients with irreversible cardiac damage who are being evaluated as heart recipients, as well as to patients who have undergone heart transplantation in the early and late postoperative periods.
ICD-10 disease diagnosis codes for patients who have undergone heart transplantation:
T86.2 Heart transplant failure and rejection;
Z94.1 Presence of heart transplant.
Heart transplant failure and rejection may also be formulated as "Cardiac allograft dysfunction" (these formulations can be considered synonymous).
1.5 Classification of the disease or condition
Critical heart failure may be a consequence of acute or decompensated chronic circulatory failure.
By LV ejection fraction:
- HFrEF (heart failure with reduced EF) (≤ 40%) (HFrEF)
- HFmrEF (heart failure with mildly reduced EF) (41% to 49%) (HFmrEF)
- HFpEF (heart failure with preserved EF) (≥ 50%) (HFpEF)
By stages of CHF — classification by the Russian Society of Cardiology experts (2024):
Pre-heart failure stage: absence of current and past symptoms and signs of CHF. Presence of structural/functional cardiac abnormalities and/or elevated natriuretic peptide levels.
Stage I: clinically manifest heart failure: presence of current and past symptoms and signs of CHF caused by structural and/or functional heart disease.
Stage II: advanced, clinically overt CHF: severe symptoms and signs of CHF, recurrent hospitalizations due to CHF decompensation despite attempts to optimize CHF therapy. [7].
To classify chronic circulatory failure in the Russian Federation, the Strazhesko-Vasilenko functional-morphological classification is used, which reflects the degree of progression of heart disease, along with the New York Heart Association (NYHA) functional classification (Appendix G1, G2).
According to the Strazhesko-Vasilenko classification, there are three stages of disease progression: I, II (A and B), and III. Stage I is characterized by the appearance of heart failure symptoms only during physical exertion and their disappearance at rest. Stage IIA is characterized by moderate signs of circulatory failure at rest limited to only one of the cardiovascular system's circulations (pulmonary or systemic), which are relieved by medical therapy including diuretics, ACE inhibitors or angiotensin II receptor blockers, beta-blockers, and potassium-sparing diuretics with antimineralocorticoid action – spironolactone** and eplerenone. Stage IIB is characterized by signs of circulatory failure in both pulmonary and systemic circulations that persist to varying degrees despite medical therapy. Patients with Stage III have marked hemodynamic disturbances and signs of venous congestion in both circulations, as well as significant impairment of organ and tissue perfusion and metabolism (Appendix G2).
The New York Heart Association functional classification of chronic heart failure (NYHA, 1964) is based exclusively on the functional assessment of severity and includes four functional classes: Class I — limitation in performing heavy physical activity, routine physical activity is not accompanied by fatigue, weakness, dyspnoea, or palpitations; Class II — mild limitation of physical activity, symptoms are absent at rest, routine physical activity causes weakness, fatigue, tachycardia, dyspnoea, etc.; Class III — marked limitation of physical activity, symptoms are absent at rest but appear with low-intensity physical activity; Class IV — inability to perform any physical activity without discomfort, heart failure symptoms are present at rest (Appendix G1).
To describe the severity of acute heart failure, the Killip classification (Table 1) or the Forrester classification (Table 2) is used; the former is based on clinical manifestations of the disease, and the latter on hemodynamic parameters.
Table 1. Killip classification of the severity of acute circulatory failure (Appendix G3)
Class | Features |
|---|---|
I | No signs of heart failure |
II | Crepitations/rales involving <50% of lung fields, third heart sound (S3), venous hypertension |
III | Pulmonary oedema (crepitations/rales involving >50% of lung fields) |
IV | Cardiogenic shock |
Table 2. Forrester classification of dz severity of acute circulatory failure (Appendix G4)
Class | PCWP (mm Hg) | CI (L/min/m²) | Clinical manifestations |
|---|---|---|---|
1 | <18 | >2,2 | Normal |
2 | >18 | >2,2 | Pulmonary congestion |
3 | <18 | <2,2 | Hypovolaemia, RV failure, Arteriolar dilatation |
4 | >18 | <2,2 | LV failure, Cardiogenic shock |
Critical circulatory failure generally implies the presence of Stage IIB-III chronic circulatory failure (Strazhesko-Vasilenko) and NYHA Class III-IV (Appendix G1, G2), or acute heart failure Class 3-4 (Killip or Forrester) (Appendix G3, G4).
1.5.1 Classification of cardiac allograft rejection
Cardiac graft rejection is currently the most significant prognostic factor for patients after heart transplantation. As a manifestation of the recipient's immune defence against foreign cells, rejection involves innate, cellular, and humoral (antibody-mediated) immune response mechanisms. Hyperacute rejection, acute cellular rejection, acute humoral rejection, and chronic rejection manifesting as graft vasculopathy or cardiac allograft vasculopathy (CAV) are distinguished.
Classification of acute cellular rejection (ISHLT 2004) (Appendix G5):
Grade 0R — no evidence of rejection, histological and immunopathological findings are negative;
Grade 1R — mild mononuclear myocardial infiltration with or without a single focus of myocyte damage;
Grade 2R — moderate mononuclear myocardial infiltration with multiple foci of myocyte damage;
Grade 3R — severe mononuclear myocardial infiltration with diffuse myocyte damage and/or signs of oedema, haemorrhage, or vasculitis.
Classification of acute antibody-mediated (humoral) rejection (ISHLT 2013) (Appendix G6):
The classification of acute antibody-mediated rejection (pAMR) takes into account both immunohistochemical and histological signs of rejection.
pAMR0 — histological and immunohistochemical signs are absent.
pAMR1 — presence of either histological signs only [pAMR1 (H+)] or immunofluorescence signs only [pAMR1 (I+)], but not both.
pAMR1(H+) — presence of histological signs only: endothelial activation, perivascular cellular infiltrate, perivascular oedema, intravascular macrophages, interstitial oedema, possible cardiomyocyte necrosis.
pAMR1(I+) — presence of immunofluorescence signs only: C4d complement component in the wall of interstitial capillaries.
pAMR2 — combination of histological and immunofluorescence signs [pAMR1(H+) + pAMR1(I+) = pAMR2].
pAMR3 — severe histological signs and diffuse C4d complement deposition in the myocardial capillary walls.
Classification of cardiac allograft vasculopathy (ISHLT 2010) (Appendix G7):
ISHLT CAV 0 (not significant): no angiographic changes detected;
ISHLT CAV 1 (mild): left main (LM) stenosis <50%, primary branch stenosis <70%, or any branch stenosis <70% (including diffuse narrowing) without graft dysfunction;
ISHLT CAV 2 (moderate): left main (LM) stenosis >50%, primary branch stenosis >70%, or any secondary branch stenosis >70% without graft dysfunction;
ISHLT CAV 3 (severe): left main (LM) stenosis >50%, stenosis of two or more primary branches >70%, or any secondary branch stenosis >70% in all three major systems; or ISHLT CAV 1 or ISHLT CAV 2 combined with graft dysfunction (defined as LVEF <45%, usually associated with regional wall motion abnormalities), or signs of significant restrictive diastolic dysfunction.
1.6 Clinical presentation of the disease or condition
1.6.1 Clinical presentation of heart failure
The clinical presentation of heart failure includes typical symptoms (dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, reduced exercise tolerance, fatigue, ankle oedema) and signs (elevated jugular venous pressure, hepatojugular reflux, gallop rhythm, displaced apical impulse to the left) caused by structural and/or functional heart disease.
Critical heart failure can be the result of acute or chronic circulatory failure.
Acute heart failure is a clinical syndrome characterized by the rapid onset or worsening of symptoms and signs of circulatory failure. Acute heart failure implies the need for immediate medical care for the patient.
Acute heart failure can be newly diagnosed in individuals without a history of cardiovascular disease, or develop as a result of decompensation of chronic heart failure.
Relatively specific clinical symptoms of chronic heart failure include orthopnea, peripheral edema, elevated jugular venous pressure, cardiomegaly, heart murmurs, and hepatomegaly. Dyspnea is the only symptom with high sensitivity, but its specificity is significantly lower. The cause of dyspnea in chronic heart failure is pulmonary congestion, which leads to increased pressure in the pulmonary veins and capillaries. Dyspnea in the early stages of heart failure is associated with physical exertion (the severity of dyspnea increases with exertion). As the disease progresses, exercise tolerance worsens: dyspnea occurs at lower levels of physical exertion, increased fatigue appears, exercise tolerance decreases, and later orthopnea develops. Clinical features of edema, detection of systemic venous hypertension, and the presence of signs of organic heart disease help to confirm or exclude a cardiovascular genesis of edema. In chronic heart failure, edema is localized in the most dependent parts of the body (lower extremities; as heart failure progresses, edema of the scrotum, abdomen, and lower back occurs) and is symmetrical.
1.6.2 Acute cellular rejection
Acute cellular rejection most commonly develops within the first few months after heart transplantation and is primarily caused by activated T-lymphocytes. During the first year after heart transplantation, acute cellular rejection develops in 20–40% of recipients. In the majority of patients, early-stage graft rejection has no clinical manifestations. Myocardial biopsy can be used to diagnose acute rejection.
Inflammation and cell death accompanying acute graft rejection initially lead to interstitial edema and decreased myocardial elasticity, which in turn manifests as impaired diastolic function. Subsequently, in the absence of adequate treatment and with the progression of the pathological process, systolic function impairment and heart failure with a reduced ejection fraction develop. Initially, acute rejection may manifest as nonspecific symptoms—general malaise, fatigue, weakness, nausea, and vomiting. Later, signs pathognomonic for heart failure appear. Right ventricular failure can develop both secondary to left ventricular failure and as a consequence of acute cellular or humoral rejection. Syncopal episodes in patients with acute rejection may result from arterial hypotension developing against the background of cardiac arrhythmias (ventricular fibrillation) or acute myocardial ischemia. In some patients, the clinical manifestation of rejection may be sudden death.
Acute graft rejection may also manifest as the development of bradyarrhythmias and atrioventricular block. As rejection progresses, fluid may be detected in the pericardial cavity. With the progression of rejection, clinical signs of low cardiac output or true cardiogenic shock appear.
1.6.3 Acute antibody-mediated rejection
Acute humoral (antibody-mediated) graft rejection is less common than acute cellular rejection, occurring in approximately 10% of patients, and is typically accompanied by signs of hemodynamic instability (symptoms of heart failure). Acute humoral rejection of the cardiac graft is primarily caused by the action of recipient antibodies against the vascular endothelial antigens of the donor organ. In addition, activated T-lymphocytes can stimulate B-lymphocytes, promoting their activation, proliferation, and differentiation into antibody-producing plasma cells.
Immunohistochemically, the diagnosis of acute humoral rejection is based on the detection of immunoglobulins (IgG, IgM, or IgA), complement system fragments (C3d, C4d, C1q), macrophages (CD68-positive cells), as well as newly circulating antibodies against donor major histocompatibility complex (HLA) molecules.
1.6.4 Quiescent antibody-mediated rejection
Signs of humoral rejection can be detected during histological examination of routine endomyocardial biopsy material in the absence of any clinical symptoms. Asymptomatic humoral rejection contributes to the progression of graft vasculopathy and is a risk factor for death. When signs of asymptomatic humoral rejection are detected in patients, the effectiveness of maintenance immunosuppressive therapy should be evaluated and drug doses adjusted if necessary.
1.6.5 Mixed rejection
The term "mixed rejection" is used when histological examination of an endomyocardial biopsy specimen simultaneously reveals signs of both cellular and humoral rejection. In the presence of signs of hemodynamic disturbances, an aggressive treatment strategy is used, including intravenous administration of glucocorticoids and immunomodulators or immunosuppressants. For mild forms of mixed rejection without hemodynamic disturbances, treatment is the same as for acute cellular rejection.
1.6.6 Late acute cardiac graft rejection, cardiac allograft vasculopathy
The frequency and schedule of routine cardiac allograft myocardial biopsies may differ across transplantation centers. Consequently, the detection rate of late acute rejection may vary. At the same time, studies have shown that more frequent routine myocardial biopsies and the associated higher detection rate of asymptomatic acute allograft rejection are not accompanied by increased patient survival during the first 5 years after heart transplantation. Some studies have shown that asymptomatic late acute rejection may resolve spontaneously without additional treatment.
Risk factors for late acute rejection include young age, a history of acute rejection episodes, sensitization to HLA antigens, female sex, and rejection episodes developing within the first few months after heart transplantation. Inadequate doses of immunosuppressants and patient non-adherence to prescribed medication regimens also contribute to the development of late acute rejection.
Cardiac allograft vasculopathy is one of the main factors influencing long-term prognosis. Despite improvements in the efficacy of cytostatic pharmacotherapy and a decrease in the incidence of cardiac graft rejection observed in recent years, the likelihood of developing graft vasculopathy remains unchanged. Because the cardiac graft is a denervated organ, myocardial ischemia is not accompanied by pain, and patients seek medical help only when myocardial ischemia leads to heart failure, which typically occurs when there are significant lesions in the coronary arteries of the transplanted heart. Therefore, early detection of changes in the graft vessels is of great importance. Non-invasive diagnostic methods have low sensitivity and specificity and, consequently, have limited use. Nevertheless, in the presence of negative dynamics in LV diastolic function parameters as one of the sensitive criteria for myocardial ischemia, they can be used to schedule an unscheduled coronary angiography.
The main screening method for detecting lesions in the coronary arteries of the transplanted heart is angiography. The first coronary angiography is usually performed shortly after the heart transplantation surgery to identify any pathological changes in the donor heart, which is especially important if the donor age is >35 years. Subsequently, repeat coronary angiographies are performed 1–2 times a year.
Because coronary artery changes in graft vasculopathy are characterized by the development of diffuse, extended, concentric stenoses, angiographic diagnosis may be difficult due to the absence of "reference" unchanged segments. Detecting "irregularities" in the internal lumen of the coronary arteries, using computer software for quantitative image analysis, and comparing with previous study results can improve the sensitivity of the method. At the same time, affected segments with compensatory vasodilation (negative remodeling of the arterial wall) are generally not detected on coronary angiography.
Additional intravascular ultrasound (IVUS) of the coronary arteries increases the sensitivity and specificity of angiography both for detecting baseline changes in the donor heart and for the early diagnosis of transplant vasculopathy. Detecting an increase in coronary intima thickness >0.5 mm within the first year after heart transplantation indicates a high risk of death or the development of hemodynamically significant graft lumen stenoses over the next 5 years.
If there is no progression of transplant coronary artery disease within 5 years after surgery, especially in patients with renal failure, follow-up coronary angiography can be performed less frequently.
Given the high incidence of restenosis and the likelihood of new lesion formation in heart recipients, especially after PCI, repeat coronary angiography should be performed no later than 12 months post-PCI.
Endothelial dysfunction is an early manifestation of cardiac allograft vasculopathy and can be diagnosed by measuring coronary flow reserve and endothelium-dependent vasodilation. Assessing coronary flow reserve allows the detection of early microcirculatory impairment even in the absence of changes in major epicardial arteries. A reduced coronary flow reserve has been shown to be a predictor of transplant vasculopathy and impaired ventricular contractile function of the graft over the subsequent 2 years.
Comorbidities (e.g., renal failure) and various technical challenges may complicate invasive angiographic evaluation.
Among non-invasive methods for the early diagnosis of transplant vasculopathy, stress echocardiography and tissue Doppler echocardiography (nomenclature code A04.10.002 (Echocardiography)) are the most informative.
2. Diagnostics, medical indications and contraindications for diagnostic methods
Criteria for diagnosing cardiomyopathy in heart transplant recipients
Dilated cardiomyopathy is diagnosed based on the following structural and functional cardiac changes not caused by myocardial ischemia, valvular heart disease, or arterial hypertension:
dilatation of the left or both ventricles (left ventricular end-diastolic volume index (LVEDVI) ≥75 mL/m2 in men and ≥62 mL/m2 in women);
marked (≤40%) or moderate (41–49%) reduction in left ventricular ejection fraction. In addition, the diagnosis of dilated cardiomyopathy should take into account the presence of the following criteria: symptoms and/or signs of heart failure; diffuse left ventricular hypokinesia; relative left ventricular wall thickness less than 0.30 (except for the dilated phase of diseases with an initially hypertrophic morphofunctional cardiac phenotype); and a verified cause of dilatation (genetic defect, toxic, endocrine, metabolic, nutritional, immune, autoimmune, post-infectious factor, pregnancy) [506].
Ischemic cardiomyopathy is diagnosed in patients with coronary artery disease, cardiomegaly, and clinical manifestations of chronic heart failure [507].
The diagnostic criterion for hypertrophic cardiomyopathy in adults is an increased left ventricular wall thickness in one or more segments of ≥15 mm (determined by any imaging modality: echocardiography/MRI/CT) that is not solely explained by increased pressure afterload [508].
2.1 Complaints and Anamnesis
See Section 1.6 Clinical Presentation.
2.2 Physical Examination
2.2.1 Physical examination of a potential heart transplant candidate to determine eligibility for the heart transplantation waiting list
If necessary, it is recommended to consult specialists: initial/follow-up examination (consultation) by a neurologist, initial/follow-up examination (consultation) by an endocrinologist, initial/follow-up examination (consultation) by a nephrologist, initial/follow-up examination (consultation) by an infectious disease specialist, initial/follow-up examination (consultation) by a dentist to make a decision on inclusion in the heart transplantation waiting list [484, 509].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
2.3 Laboratory Diagnostics
2.3.1 Laboratory diagnostic tests for a potential heart transplant candidate to determine eligibility for the heart transplantation waiting list.
To select a donor-recipient pair and ensure blood transfusion compatibility, it is recommended that all potential heart recipients undergo ABO blood grouping, Rhesus factor (D antigen) testing, HLA antigen typing, and a crossmatch test using recipient immune antibodies and donor major histocompatibility complex antigens [484].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
It is recommended that all potential heart recipients undergo an intradermal tuberculosis allergen test, molecular blood testing for Epstein–Barr virus, molecular blood testing for Cytomegalovirus, determination of hepatitis B virus surface antigen (HBsAg) in the blood (Hepatitis B virus), determination of antibodies to hepatitis C virus (Hepatitis C virus) in the blood, determination of IgM and IgG antibodies (IgM, IgG) to human immunodeficiency virus HIV-1 (Human immunodeficiency virus, HIV 1) in the blood, determination of IgM and IgG antibodies (IgM, IgG) to human immunodeficiency virus HIV-2 (Human immunodeficiency virus, HIV 2) in the blood, and determination of antibodies to Treponema pallidum [484].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
It is recommended that all potential heart recipients undergo blood testing for N-terminal pro-B-type natriuretic peptide (NT-proBNP) to decide on inclusion in the heart transplantation waiting list [484, 510, 511].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
2.3.2 Laboratory diagnostic examinations in heart recipients
It is recommended that all adult patients after heart transplantation undergo regular therapeutic drug monitoring of immunosuppressants (tacrolimus** or #everolimus** depending on the prescribed immunosuppressive regimen) in the blood [481, 482].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
2.4 Instrumental Diagnostics
Instrumental diagnostic evaluations of a potential heart transplant candidate to determine eligibility for the heart transplantation waiting list
It is recommended that all potential heart recipients undergo M- and B-mode transthoracic echocardiography (including pulmonary artery pressure estimation), and where indicated, assessment of chronic heart failure severity (functional class determination using the 6-minute walk test), cardiopulmonary exercise testing, and right heart catheterization to decide on inclusion in the heart transplantation waiting list [208, 484].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended that all potential heart recipients undergo brain computed tomography to decide on inclusion in the heart transplantation waiting list [208, 484, 513, 515].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
All adult potential heart recipients are recommended to undergo evaluation of the extracranial brachiocephalic arteries to decide on inclusion in the heart transplantation waiting list. All recipients who may potentially be considered for mechanical circulatory support implantation as a "bridge to transplant" are also recommended to undergo duplex scanning of the lower extremity vessels (arteries and veins) for the same purpose [208, 514, 515].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended that all potential heart recipients undergo chest computed tomography to decide on inclusion in the heart transplantation waiting list [208, 484, 512].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended that all potential heart recipients undergo abdominopelvic and retroperitoneal computed tomography to decide on inclusion in the heart transplantation waiting list [208, 484, 513, 515].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended that all potential heart recipients undergo transvenous diagnostic right heart catheterization to determine intracardiac pressures, cardiac output (CO), cardiac index (CI), transpulmonary gradient (TPG), and pulmonary vascular resistance (PVR) for inclusion in the heart transplantation waiting list [208, 484].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comments: The primary objectives of transvenous right heart catheterization are to obtain accurate parameters characterizing the contractile function of the right and left sides of the heart and to detect potential signs of pulmonary hypertension, which is a contraindication to orthotopic heart transplantation.
In individuals over 18 years of age who are candidates for heart transplantation, with a pulmonary artery systolic pressure (PASP) >50 mm Hg and/or transpulmonary gradient (TPG) >15 mm Hg, and pulmonary vascular resistance (PVR) >3 Wood units at a systolic blood pressure during measurement >85 mm Hg, it is recommended to repeat the measurements while administering drugs with pulmonary vasodilator effects (ATC code C02KX Antihypertensives for pulmonary arterial hypertension) to confirm the reversibility of pulmonary hypertension [485]. A decrease in TPG <12–15 mm Hg and PVR <2.5–3 Wood units at a systolic blood pressure during measurement >85 mm Hg indicates the reversibility of pulmonary hypertension [348].
GCP CLE 4Grade of Recommendation C (Level of Evidence 4)
In the case of irreversible pulmonary hypertension according to right heart catheterization data, heart transplantation in adults is not recommended. In this case, it is recommended to consider the use of an implantable ventricular assist device*** for the treatment of pulmonary hypertension [486].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Comments: In this case, the use of mechanical circulatory support devices should be considered as an alternative to heart transplantation or medical therapy for the treatment of pulmonary hypertension. Adequate medical therapy, including agents that reduce pulmonary vascular pressure or implantable ventricular assist systems, may be accompanied by a decrease in pulmonary vascular resistance within 3–6 months, after which orthotopic heart transplantation can be performed.
2.5 Other Procedures
Postoperative monitoring of heart transplant recipients
During perioperative monitoring of adult heart recipients, it is recommended to perform electrocardiographic monitoring (A05.10.007), invasive and non-invasive blood pressure measurement on peripheral arteries (A02.12.002), central venous pressure measurement (A02.12.003), thermodilution hemodynamics assessment (A24.12.001), percutaneous oxygen partial pressure monitoring (A05.12.008), intraoperative transesophageal echocardiography, and continuous urine output evaluation for the timely application of complication management methods [495–500].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
If antibody-mediated rejection is suspected, it is recommended to perform a pathomorphological examination of myocardial biopsy (surgical) material, including pathomorphological examination using immunohistochemical methods to detect complement system components and specific antibodies [208, 487].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to perform a follow-up myocardial biopsy 3 to 12 months after heart transplantation to detect heart graft rejection in adult patients [488].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to perform echocardiography to monitor heart graft rejection in adult recipients at low risk of heart graft rejection or in whom myocardial biopsy is not feasible (e.g., due to tricuspid regurgitation or vascular access difficulties) [490].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to perform contrast-enhanced cardiac magnetic resonance imaging in adult patients with an undetermined cause of graft dysfunction and in the absence of histological confirmation of rejection on myocardial biopsy to determine the cause of dysfunction [491].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to perform coronary angiography with intravascular ultrasound of the vessel wall or optical coherence tomography of the coronary arteries in patients with cardiac allograft vasculopathy for the differential diagnosis of late acute heart graft rejection [19, 20, 21, 22, 56, 208].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to perform intravascular ultrasound of the coronary arteries 4–6 weeks and one year after heart transplantation, which allows for the assessment of long-term prognosis, detection of atherosclerotic lesions in the donor heart, and diagnosis of rapidly progressive cardiac allograft vasculopathy [304, 305, 308].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1 Indications and contraindications for heart transplantation
3.1.1 Indications for heart transplantation
Heart transplantation is recommended for adult patients with end-stage heart failure accompanied by clinically significant signs of circulatory decompensation and unfavorable life prognosis, despite maximally tolerated disease-modifying medical therapy, when other organ-sparing interventions are impossible, and in the absence of contraindications. Heart transplantation is performed to improve the patient's prognosis and quality of life [2, 9].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comments: The presence of one or more clinical signs or symptoms of progressive heart failure is associated with a worsening prognosis; the identification of these clinical indicators should facilitate the timely referral of the patient to a transplant center to address inclusion on the heart transplant waiting list [16–19]. It is important to note that in patients with preserved left ventricular ejection fraction (restrictive or valvular cardiomyopathies, isolated right ventricular (RV) failure, or congenital heart disease), the issue of waiting list inclusion may be relevant if there are signs of chronic heart failure progression [20–22] (Appendix G8). Early detection of these clinical signs of disease progression is important for the timely assessment of transplantation feasibility, as late detection may result in patients no longer being considered potential heart recipients [1, 2, 7, 9].
Indications for referral to a transplant center
When determining indications for referring an adult patient with severe heart failure to a transplant center to evaluate surgical treatment methods, it is primarily recommended to assess [2]:
^ disease progression despite maximal disease-modifying drug therapy;
^ inability to prescribe maximal disease-modifying drug therapy due to low systolic blood pressure (SBP <90 mm Hg);
^ inability to relieve chronic heart failure symptoms despite increasing the dose of loop diuretics;
^ need for inotropic therapy to compensate for decompensated chronic heart failure;
^ frequency of hospitalizations for chronic heart failure decompensation more than twice a year;
^ impairment of vital organ function against the background of progressing heart failure;
^ peak oxygen consumption (peak VO2) <12 mL/kg/min in patients not receiving beta-blockers and peak VO2 <14 mL/kg/min while taking the maximally tolerated dose of beta-blockers;
^ increasing natriuretic peptide levels over time despite ongoing maximal disease-modifying drug therapy;
^ recurrent life-threatening arrhythmias refractory to medical therapy and electrophysiological treatment methods (radiofrequency ablation of arrhythmogenic zones) and/or implantation of a single-, dual-, or triple-chamber (biventricular) cardioverter-defibrillator***) [2, 9].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Indications for heart retransplantation
Due to the increasing number of primary heart transplant persons worldwide in recent years, there is a clear upward trend in such procedures from 3% to 7%.
In patients after heart transplantation with irreversible heart graft dysfunction, before retransplantation, it is recommended to repeat the same evaluations as before the first transplantation to rule out contraindications [19, 10, 21].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Comment: This statement is correct both for determining indications and for assessing potential contraindications.
When evaluating heart transplant recipients to determine indications for retransplantation, it is recommended to pay special attention to the following clinical aspects [9, 10, 21, 22, 129–132]:
^ presence and severity of renal failure, as well as the presence of comorbidities (acquired after primary transplantation or preexisting) that significantly increase the risk of death after retransplantation;
^ indication for retransplantation and the time elapsed since primary transplantation.
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Performing retransplantation for primary graft dysfunction (especially within 30 days of primary transplantation) carries a higher risk of mortality than retransplantation for cardiac allograft vasculopathy (especially if performed more than 2 years after primary transplantation) [131–133].
When considering heart retransplantation, an age over 60 years should be considered a relative contraindication for inclusion in the heart transplant waiting list; the decision is made based on the totality of risk factors affecting the prognosis of survival after heart retransplantation. Patients with cardiac graft dysfunction due to an acute rejection crisis have contraindications for inclusion in the heart retransplantation waiting list [191,193-196]. The issue of heart retransplantation is of an ideological and ethical nature rather than a matter of exclusively determining medical indications and contraindications. Given the current global organ shortage, the issue of the feasibility of performing heart retransplantation, which is associated with statistically significantly worse survival outcomes, remains open to date.
3.1.2 Relative contraindications
Heart transplantation is not recommended in individuals over 65 years of age with concomitant clinically significant syndromes or diseases associated with an increased risk of perioperative complications, since medical therapy allows for achieving a longer life expectancy and higher quality of life [2, 31, 56].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comments: Currently, the factor determining the feasibility of heart transplantation is not so much age as the presence of comorbid conditions and the patient's ability to achieve remission after surgery. In older individuals, expanded criteria for organ donation are used.
Heart transplantation is not recommended for obese patients characterized by a body mass index of 30–35 kg/m2, due to the high risk of perioperative complications [2, 56, 208].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In the presence of the following comorbid conditions, heart transplantation is not recommended, as surgical treatment in these cases reduces life expectancy and impairs its quality:
- peptic ulcer disease in exacerbation phase;
- diabetes mellitus with target organ damage (neuropathy, nephropathy, or retinopathy). Relative contraindications for heart transplantation in patients with diabetes mellitus include the presence of target organ damage (except for non-proliferative retinopathy) and the inability to achieve adequate glycemic control (glycated hemoglobin levels >7.5% or 58 mmol/mol);
- the presence of hemodynamically significant atherosclerosis of the head and neck arteries, lower limb arteries, renal arteries, significant atherosclerosis and calcification of the ascending aorta are relative contraindications for heart transplantation and mechanical circulatory support device implantation;
- acute infectious diseases (except for infectious complications associated with mechanical circulatory support devices);
- chronic renal failure with a creatinine level >2.5 mg/dL or creatinine clearance <30 mL/min/1.73 m2 is regarded as a relative contraindication for heart transplantation. However, there is currently experience of combined and sequential (delayed) kidney transplantation, including in Russia;
- hepatic failure with a bilirubin level >2.5 mg/dL, an increase in aminotransferase activity by more than 3 times, INR >1.5 without warfarin**;
- impaired external respiration function characterized by an FEV1 value <40%;
- coagulopathy;
- a history of infarction pneumonia within the preceding 6–8 weeks;
- severe neurological or neuromuscular disorders;
- cachexia [2, 56, 208].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comments: Wasting, or cachexia, in patients with heart failure is an unfavorable factor associated with a higher risk of adverse events and mortality. This may be due to an older age, longer duration, and greater severity of the disease, which can also affect the risk of perioperative complications and the ability to recover in the postoperative period. Criteria for the diagnosis of cachexia include weight loss of more than 5% over the past year or a body mass index at the initial patient examination of <20 kg/m2 and the presence of 3 out of 5 signs: decreased muscle strength, weakness, anorexia, asthenic build, laboratory parameters (high levels of C-reactive protein or IL-6, anemia, hypoalbuminemia).
Heart transplantation is not recommended for patients with conditions and diseases that may be accompanied by non-adherence to the drug regimen in the postoperative period due to high risks of graft rejection/complications of immunosuppressive therapy:
- unfavorable social status or mental illness in which remission cannot be achieved;
- a history of acute cerebrovascular accident; episodes of drug or alcohol abuse within the past 6 months; inability to quit tobacco smoking [2, 56, 208].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Heart transplantation is not recommended in the presence of chronic infectious diseases due to high risks of complications:
- Human immunodeficiency virus. Heart transplantation can be performed in patients with HIV antibodies in the blood in the absence of opportunistic infections (for >1 month), receiving combined etiotropic antiviral therapy (for >3 months), in the absence of detectable HIV RNA in the blood (for >3 months), and in the absence of lymphopenia (blood CD4-positive cell count >200 cells/mcL for >3 months). Patients with primary central nervous system lymphoma or visceral Kaposi sarcoma are not considered potential heart transplant recipients;
- Hepatitis B and C viruses. Patients with resolved or inactive hepatitis B and hepatitis C virus infection can be included in the HT waiting list [2, 56, 208].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.1.3 Absolute contraindications
Heart transplantation is not recommended for patients older than 70 years with comorbid conditions that increase perioperative risk and limit long-term prognosis, since in this case surgical treatment reduces life expectancy and impairs its quality [2, 31, 56].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Heart transplantation is not recommended for patients with comorbid conditions to reduce the risk of perioperative complications:
- marked impairments in external respiration function (e.g., severe chronic obstructive pulmonary disease with FEV1 <1 L/min);
- pulmonary hypertension with a transpulmonary gradient >15 mm Hg or pulmonary vascular resistance >3 Wood units, refractory to medical therapy and/or mechanical circulatory support; pronounced liver and/or kidney dysfunction;
- autoimmune diseases (systemic lupus erythematosus, sarcoidosis, or systemic amyloidosis);
- severe obesity (BMI >35 kg/m2);
- malignancies within the last 10 years;
- pronounced atherosclerosis of the carotid, cerebral, and peripheral arteries when surgical treatment is not feasible;
- presence of an acute viral infection, including fulminant forms of hepatitis B and C;
- presence of clinical, radiological, biochemical, or morphological signs of liver cirrhosis, portal hypertension, or hepatocellular carcinoma and other oncological processes [2, 56, 208, 504].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Heart transplantation is not recommended for patients with comorbid conditions associated with a 5-year risk of death exceeding 50% (e.g., malignancies with an unfavorable life prognosis), since in this case surgical treatment reduces life expectancy and impairs its quality [2, 56, 208].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.2 Surgical techniques for heart transplantation
The following surgical techniques for orthotopic heart transplantation are recommended: bicardiac (anastomoses are placed between the donor and recipient atria) and bicaval (anastomoses are placed between the donor and recipient venae cavae) for performing heart transplantation in adult and pediatric patients [207, 208].
Level of confidence rating C (level of evidence 3)
Inpatient postoperative period in heart transplant recipients
The main task of the early post-transplant period is to restore the contractile function of the cardiac allografting adequate to the metabolic demands of the recipient's body. A combination of all modern methods for correcting donor heart function (both pharmacological and utilizing contemporary mechanical circulatory support systems) is required, based on continuous monitoring of central hemodynamics, metabolic parameters, blood gas exchange and oxygen transport function, along with careful surveillance of other vital organs. In cases of severe impairment of graft contractility, systemic hemodynamics is maintained using mechanical circulatory support. In extreme cases, if the function of the transplanted heart does not recover, retransplantation is required.
Recommendations on inotropic therapy in the perioperative transplant period
It is recommended to use dopamine** or dobutamine** in adult heart recipients during and after surgery for inotropic hemodynamic support. [59, 313]
GCR BLOC 3Grade of Recommendation B (Level of Evidence 3).
It is recommended to use levosimendan** in adult heart recipients weighing over 40 kg for the treatment of patients following heart transplantation. The hemodynamic indications for levosimendan** therapy are: RAP >12 mm Hg, PCWP >15 mm Hg, CI <2.5 L/min/m2 when inotropic therapy with dopamine** and/or dobutamine** >15 mcg/kg/min is required [493, 494]
GRL CLEL 4Grade of Recommendation C (Level of Evidence 4)
3.3 Immunosuppressive therapy
All cardiac allograft recipients are recommended lifelong immunosuppressive therapy starting from the time of heart transplantation to prevent rejection of the transplanted heart [208, 501].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comment: The risk of cardiac allograft rejection persists for life. The success of heart transplantation largely depends on the development of effective immunosuppressive therapy strategies. The goal of combined immunosuppressive pharmacotherapy in post-heart transplant patients is the prevention of acute graft rejection, vasculopathy, and infectious as well as non-infectious postoperative complications. Currently, induction and maintenance immunosuppressive therapy are distinguished, alongside adjunctive agents for treating graft rejection. The necessity for perioperative induction immunosuppression stems from the fact that the immune response against the donor organ is most pronounced in the first hours after transplantation, which is explained by the pronounced expression of donor antigens caused by the agonal state, brain death of the donor, ischemia-reperfusion injury, and surgical trauma. Induction immunosuppressive therapy can significantly reduce the risk of rejection or donor organ dysfunction.
Induction immunosuppressive therapy in heart recipients
The decision to use induction immunosuppressive therapy during heart transplantation is made individually for each patient, taking into account the risk of acute graft rejection, renal dysfunction, infectious complications, and malignancies [502].
Convincing evidence regarding the efficacy and safety of the routine use of induction immunosuppressive therapy has not currently been obtained [468].
For heart transplantation in adults, induction immunosuppressive therapy using #basiliximab** at a dose of 20 mg administered as a single intravenous infusion, with a repeat intravenous infusion of 20 mg on the fourth day post-transplantation, is recommended for the prevention of acute cardiac allograft rejection [450].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Administration of antithymocyte globulin** is recommended for adult recipients at high risk of cardiac allograft rejection (patients with donor-specific antibodies, females who have had pregnancies, etc.), as well as for adult patients with impaired renal function to prevent acute cardiac allograft rejection [503].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to use #basiliximab** in adult heart recipients at a dose of 10 mg for recipients with an anticipated elevated risk of opportunistic infections as a priority agent for induction immunosuppression [466].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
3.3.1 Maintenance immunosuppressive therapy
Calcineurin inhibitors – tacrolimus** or cyclosporine** – are recommended for all adult patients for maintenance immunosuppressive therapy following heart transplantation [249].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Dosage titration of tacrolimus** based on blood concentration is recommended for all adult patients after heart transplantation to reduce the risk of cardiac allograft rejection and minimize adverse drug reactions. Target blood concentrations of tacrolimus**: up to 12 months – 10–15 ng/mL, beyond 12 months – 5–10 ng/mL [249].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Glucocorticoid administration is recommended for all patients as part of induction and maintenance immunosuppressive therapy following heart transplantation to prevent cardiac allograft rejection, as well as to treat cardiac allograft rejection [249, 473–475].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
A combination of tacrolimus** with prednisolone** and mycophenolic acid** or mycophenolate mofetil** is recommended for adult heart recipients. Considering the narrow therapeutic window of immunosuppressants, the high risk of adverse reactions, and undesirable drug interactions, it is recommended to tailor immunosuppressive therapy to the individual characteristics of patients in order to prevent cardiac allograft rejection [241].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Glucocorticoid withdrawal within 3–6 months after heart transplantation is recommended in patients with a low risk of graft rejection (patients without circulating anti-HLA antibodies, nulliparous women, patients without a history of rejection, older patients) to minimize adverse effects of treatment [246, 249, 505].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Use of the proliferation signal inhibitor (mTOR inhibitor) #everolimus** as part of immunosuppressive therapy
In adult heart recipients with vasculopathy and/or nephropathy, switching from mycophenolate mofetil** to #everolimus** is recommended 6 months after surgery to reduce the risk of undesirable nephrotoxic effects and coronary allograft vasculopathy. #Everolimus** is prescribed to adult heart recipients for life as capsules or tablets twice daily, with dosage titration based on blood drug concentration (target trough concentration level of 3–6 ng/mL). Titration is initiated at an initial dose of 0.75 mg twice daily or 1.5 mg twice daily and adjusted according to blood concentration results [255, 260].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
In adult heart recipients, the prescription of #everolimus** within the first six months post-transplantation is not recommended for the prevention of transplanted heart rejection [259, 476].
GCR BLOC 2Grade of Recommendation B (Level of Evidence 2)
Comment: The high frequency of adverse reactions associated with these agents, including delayed postoperative wound healing, limits their widespread use in the early post-transplant period [476].
In adult heart recipients, switching from mycophenolate mofetil** to protein kinase inhibitors to reduce the dose of tacrolimus** or cyclosporine** for the prevention of the latter's nephrotoxic effects is not recommended, due to the fact that #sirolimus and #everolimus** may potentiate the nephrotoxic effects of tacrolimus** or cyclosporine** [241, 254].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Patients with a transplanted heart are recommended to undergo regular blood testing for drug levels (immunosuppressants) to detect and correct low and high drug concentrations in the blood, aiming to prevent cardiac allograft rejection (in case of low blood drug levels) or adverse drug reactions (in case of high blood levels) [519].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Non-immunosuppressive (adjuvant) pharmacotherapy
Adult heart recipients, regardless of cholesterol levels, are recommended to be prescribed HMG-CoA reductase inhibitors (statins) to prevent stenosing arterial lesions [265, 266].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
Adult heart recipients are recommended to be prescribed initial doses of HMG-CoA reductase inhibitors lower than those recommended for the prevention of adverse events in the general population, taking into account drug interaction profiles, to prevent adverse treatment reactions [271].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to prescribe HMG-CoA reductase inhibitors to patients after heart transplantation to reduce the risk of cardiac allograft vasculopathy and improve event-free survival, including reducing the risk of malignancies and improving overall survival [269-271].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.4 Treatment of cardiac allograft rejection
Acute cellular rejection of the cardiac allograft manifests as a decrease in myocardial contractility.
3.4.1 Recommendations for the treatment of acute cellular rejection
When acute allograft rejection is suspected, it is recommended to perform a myocardial biopsy in adult patients to confirm or rule out rejection [284, 434].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Patients presenting with a clinical picture of a rejection crisis should be hospitalized, and in the presence of concurrent hemodynamic disturbances, transfer to an intensive care unit is recommended for timely follow-up examination and treatment intensification [285].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
High-dose intravenous corticosteroid pulse therapy is recommended as a first-line treatment in the presence of clinical symptoms of acute cellular rejection, regardless of the severity grade, to minimize the risk of complications [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
If signs of hemodynamic impairment persist despite corticosteroid pulse therapy or if there are no signs of improvement within 12-24 hours after the initiation of corticosteroid administration, it is recommended to administer antithymocyte immunoglobulin** to improve treatment outcomes [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to administer intravenous cardiotonic agents, excluding cardiac glycosides (ATX group C01C), to maintain adequate cardiac output and systemic blood pressure until adequate contractility of the cardiac allograft is restored in adults [504].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Concurrently with corticosteroid pulse therapy and the administration of immunomodulators or immunosuppressants, it is recommended to administer antibacterial therapy in adults to prevent bacterial infection [506].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
To reduce the risk of rejection recurrence, it is recommended to prescribe adequate maintenance immunosuppressive therapy. Possible options for adjusting maintenance immunosuppressive therapy include increasing the doses of current immunosuppressants, adding a new agent, or substituting one drug for another. Patient adherence to the medication regimen must also be assessed [208, 231].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
The next myocardial biopsy is recommended to be performed 1-2 weeks after the initiation of treatment for acute cellular rejection to confirm the therapeutic effect [208, 237].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
To assess treatment efficacy in adult patients with acute rejection, it is recommended to perform transthoracic echocardiography evaluating the contractility of the cardiac allograft [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In patients with clinical signs of heart failure and mild acute cellular rejection assessed by histological examination, it is recommended to administer the same treatment as for acute humoral (antibody-mediated) rejection to reduce the risk of complications [208, 285].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Basiliximab** is not recommended for the treatment of acute cellular rejection of the cardiac allograft in adults [450].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
3.4.2 Recommendations for the treatment of quiescent acute cellular rejection
If histological signs of severe acute cellular rejection are detected during routine pathomorphological examination of myocardial biopsy (surgical) tissue, treatment is recommended despite the absence of rejection symptoms or graft dysfunction, in order to prevent complications [296].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
In severe asymptomatic acute cellular rejection, it is recommended to administer intravenous corticosteroid pulse therapy to improve treatment outcomes [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Systemic antibacterial prophylaxis is recommended to be included in the drug therapy for rejection in adults to improve treatment outcomes [506].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
A repeat myocardial biopsy is recommended 2-4 weeks after the initiation of treatment for severe or moderate asymptomatic acute cellular rejection to confirm the therapeutic effect [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
The administration of immunomodulators or immunosuppressants is recommended in the absence of histological regression of acute cellular rejection to improve treatment outcomes [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Asymptomatic moderate acute cellular rejection occurring more than a year after heart transplantation may also spontaneously regress without treatment, but in such cases, careful monitoring is recommended, including clinical evaluation, echocardiography, and repeat myocardial biopsies to confirm the regression of rejection [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.4.3 Recommendations for the treatment of recurrent/resistant cellular rejection of the cardiac allograft
In recurrent or steroid-resistant acute cellular rejection, it is recommended to administer antithymocyte immunoglobulin** to prevent complications [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
If a patient develops a recurrent or steroid-resistant cellular rejection crisis, the maintenance immunosuppressive therapy regimen should be revised for more effective treatment [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Regardless of the presence and severity of clinical signs of cardiac allograft failure, adult patients with recurrent or treatment-resistant cellular rejection are recommended to undergo regular repeat echocardiographic examinations to monitor allograft contractility [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to perform an additional histological examination for the presence of a humoral rejection component and determine the presence of anti-HLA antibodies in the recipient's blood to optimize therapy [285].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.4.4 Recommendations for the treatment of hyperacute rejection
Treatment of hyperacute rejection is recommended to be initiated immediately upon detection, preferably while still in the operating room. Treatment may include: 1) intravenous corticosteroid pulse therapy, 2) plasmapheresis, 3) intravenous administration of normal human immunoglobulin**, 4) administration of immunomodulators or immunosuppressants, 5) intravenous administration of cardiotonic agents excluding cardiac glycosides (ATX group C01C), 6) mechanical circulatory support to improve treatment outcomes [275].
Level of Evidence CGrade of Recommendation 2Level of Evidence C (Grade of Recommendation 2)
For the treatment of cardiac allograft rejection, it is recommended to use normal human immunoglobulin** at a dose of 2 g/kg (the dose should be divided over 2 days) or 2-3 g/kg (the dose should be divided over 4 days) [275]
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
To confirm the diagnosis of hyperacute rejection, it is recommended to perform an intraoperative myocardial biopsy [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
If the aforementioned treatment methods are ineffective, adult recipients are recommended to undergo emergency heart retransplantation to improve treatment outcomes [326].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
3.4.5 Recommendations for the treatment of acute antibody-mediated cardiac allograft rejection
To reduce the damaging effect of antibodies on the cardiac allograft, it is recommended to use: high-dose intravenous corticosteroids and/or immunomodulators or immunosuppressants [285, 288].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
To remove circulating anti-HLA antibodies or reduce their activity in adult patients, it is recommended to use: plasmapheresis, immunoadsorption, intravenous infusion of normal human immunoglobulin** preparations (20 g) in a solution at a rate of 0.01-0.02 mL per kg of patient weight per minute [291].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
To maintain adequate cardiac output and blood pressure in adult patients, it is recommended to: administer cardiotonic agents excluding cardiac glycosides (ATX group C01C), and use mechanical circulatory support [230, 284].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
When humoral rejection is suspected, it is recommended to perform a pathomorphological examination of myocardial biopsy (surgical) tissue, including immunohistochemical methods to detect complement system components and specific antibodies [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
A repeat myocardial biopsy with immunohistochemical examination is recommended to assess the treatment effect 1-4 weeks after the initiation of humoral rejection therapy [237, 436].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
If necessary, it is recommended to adjust the maintenance immunosuppressive therapy: increase the dose of current medications, add a new drug, or substitute one drug for another to increase therapeutic efficacy [231, 249, 260].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to prescribe anticoagulant therapy in adults to reduce the risk of cardiac allograft vascular thrombosis [85, 208].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
If therapy fails in adult patients with acute humoral rejection, it is recommended to consider the feasibility of emergency retransplantation to improve treatment outcomes [359].
EcoL CLoE 4Level of Evidence C (Level of Confidence of Evidence 4)
3.4.6 Recommendations for the treatment of late acute graft rejection
When signs of acute cardiac allograft rejection are detected, it is recommended to evaluate the adequacy of prescriptions and patient adherence to the immunosuppressive therapy regimen in order to improve treatment outcomes [231, 276, 346].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to educate patients on identifying clinical signs of graft rejection in themselves and to explain the necessity of strict adherence to prescribed drug therapy and lifestyle regimens to reduce the risk of adverse events and improve the long-term prognosis [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Frequent repeat myocardial biopsies in patients at low risk of rejection are not recommended, as they do not contribute to improving the prognosis; the risk of complications during myocardial biopsy should be taken into account [237, 436].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
In patients at low risk of graft rejection, the use of non-invasive functional diagnostic methods in the long-term period after heart transplantation is recommended in order to reduce the risk of repeated myocardial biopsies [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.5 Recommendations for the diagnosis and treatment of cardiac allograft vasculopathy
In adult patients after heart transplantation with cardiac allograft vasculopathy (CAV), instead of mycophenolate mofetil** or azathioprine**, it is recommended to prescribe protein kinase inhibitors in order to improve survival and quality of life [342].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Coronary artery angioplasty with stenting is recommended for adult patients with CAV for effective myocardial revascularization when feasible [356, 357].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Repeat coronarography is recommended for adult heart transplant recipients after coronary artery angioplasty due to a higher risk of restenosis, in order to improve the diagnosis of coronary artery lesions [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.6 Repeat heart transplantation (retransplantation)
According to international data, the frequency of repeat heart transplantations is approximately 3%. The most common indications for retransplantation include cardiac allograft vasculopathy, chronic rejection, as well as primary graft dysfunction and acute rejection. A more favorable prognosis after heart transplantation is observed in recipients who underwent retransplantation due to primary graft vasculopathy and chronic graft rejection, while a less favorable prognosis is noted in patients with acute rejection or primary graft dysfunction.
In patients with signs of irreversible impairment of cardiac allograft contractility or severe CAV in the absence of contraindications, repeat heart transplantation is recommended in order to increase life expectancy and improve its quality [359-361].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comment: The most effective treatment method for graft vasculopathy when coronary artery angioplasty is not feasible, especially in patients with signs of impaired heart allograft contractility, is retransplantation. It should be noted that survival during the first year after retransplantation is lower than after primary heart transplantation, which is apparently due to the severity of the patients' condition and the specifics of the perioperative period. According to various registries, the frequency of repeat heart transplantations is approximately 3%. The most common indications for retransplantation include cardiac allograft vasculopathy, as well as primary dysfunction and acute rejection. Patient survival after retransplantation is lower than after primary heart transplantation, being approximately 5% at 1 year and 38% at 5 years. A more favorable prognosis after heart transplantation is observed in patients who underwent retransplantation due to primary graft vasculopathy, and a less favorable prognosis in patients with acute rejection or primary graft dysfunction.
Consideration of retransplantation is recommended in recipients with clinical manifestations of heart failure in the absence of signs of acute graft rejection in order to increase life expectancy and improve its quality [326-329].
GRC CLEL 5Grade of Recommendation C (Level of Evidence 5)
Consideration of retransplantation is recommended in recipients with pronounced changes in the graft coronary arteries with no or minor/moderate signs of heart failure in order to increase life expectancy and improve its quality [326-329].
GRC CLEL 5Grade of Recommendation C (Level of Evidence 5)
Consideration of retransplantation is recommended in recipients with heart failure that developed against the background of acute graft rejection within the first months after the first heart transplantation in order to increase life expectancy and improve its quality [326-329].
GRC CLEL 5Grade of Recommendation C (Level of Evidence 5)
3.7 Management of heart transplant patients
Orthotopic heart transplantation is an effective treatment method for end-stage heart failure, which significantly improves survival, quality of life, exercise tolerance, and restores patients' working capacity [330].
The immunosuppressive therapy currently used in heart transplant recipients effectively prevents the development of transplanted organ rejection in patients. At the same time, the side effects of these medications can have a negative impact on prognosis and quality of life.
Being highest in the first months and decreasing after a year or more following the transplantation surgery, the risk of heart graft rejection persists for life, which determines the need for continuous immunosuppressive therapy. The side effects of immunosuppressive therapy have a negative impact on prognosis and quality of life. The most significant side effects include the development of malignant neoplasms, the risk of infectious complications, nephropathy, diabetes mellitus, arterial hypertension, neurological disorders, osteoporosis, effects on reproductive health, etc.
Clinically, cardiac allograft rejection manifests as circulatory failure. In most patients, graft rejection in the early stages has no clinical manifestations, and the clinical manifestation of rejection can be sudden death. This necessitates regular scheduled myocardial biopsies (see Postoperative monitoring of heart transplant recipients) for the early detection of rejection signs and timely initiation of treatment [345, 346].
Cardiac allograft vasculopathy is one of the main factors influencing the long-term prognosis. Due to the fact that the cardiac allograft is a denervated organ, myocardial ischemia is not accompanied by pain, and patients seek help on their own only when myocardial ischemia leads to heart failure, which, as a rule, already occurs with significant changes in the coronary arteries of the transplanted heart. In this regard, early detection of graft vascular changes is of great importance [347].
3.8 Recommendations for performing surgical interventions in patients with a transplanted heart
Prophylactic antibiotic therapy before surgery is recommended to prevent complications [275].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comment: When prescribing systemic antibacterial drugs, aminoglycosides should be avoided due to the possible progression of renal failure against the background of tacrolimus** or cyclosporine** use.
During anesthetic management, it is recommended to take into account that the cardiac allograft is denervated, in order to prevent anesthesia complications [275].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comment: Resting heart rate in heart transplant recipients is higher than in other individuals: normal heart rate is 90 min-1; an increase in heart rate up to 130 min-1 does not require drug therapy. Atropine** in patients with a transplanted heart does not increase heart rate due to the fact that the graft is denervated. Bradyarrhythmias are managed with cardiac pacing.
3.9 Diet therapy
Diet therapy is carried out within the framework of the underlying disease.
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Patients who have undergone heart transplantation are recommended psychological, physical, and social rehabilitation aimed at the treatment and prevention of depressive disorders, socialization, the development of discipline in following medical recommendations regarding medication and lifestyle, as well as the promotion of autonomy and independence in order to improve the quality of life [275, 361].
Level of reliability of recommendations CLevel of evidence validity 5Level of reliability of recommendations C (level of evidence validity 5)
Comments: Patients are included in secondary prevention and rehabilitation programs. A well-designed physical and psychological rehabilitation program helps improve adherence to drug therapy and lifestyle modification measures, including diet, regular physical activity, and smoking cessation. After determining individual exercise tolerance and assessing the associated risks, the rehabilitation program includes regular aerobic exercise (training) at least 3 times a week for a minimum of 30 minutes each session. Sedentary patients should be actively encouraged to start low-intensity physical rehabilitation programs.
4.1 Recommendations for physical therapy and physical rehabilitation programs in adult patients after heart transplantation
All adult patients after heart transplantation are recommended aerobic exercise training to improve clinical status [363-366].
GCR BLOC 2Grade of Recommendation B (Level of Evidence 2)
Comment: Exercise training improves exercise capacity and contributes to the modification of cardiovascular risk factors, such as obesity, impaired glucose tolerance, and arterial hypertension. The effect of exercise training on long-term prognosis and mortality in patients after heart transplantation has not been studied.
Resistance training is recommended for patients with signs of decreased bone mineral density, as well as for the prevention of osteoporosis and adverse effects of glucocorticoids and tacrolimus** or cyclosporine** on muscle tissue [368].
CGR CLEL 4Grade of Recommendations C (Level of Evidence 4)
Comment: Resistance training is part of a comprehensive therapy to prevent bone mineral density loss and skeletal muscle atrophy.
4.2 Recommendations for the social rehabilitation of patients after heart transplantation
Resumption of social activity and employment after heart transplantation is recommended in adults to improve quality of life [369].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Resumption of employment by adult patients after heart transplantation (possibly with the support of social services) is recommended for socialization [275, 370].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
4.3 Recommendations for the prevention and treatment of depressive states in patients after heart transplantation
Selective serotonin reuptake inhibitors, especially citalopram and newer-generation antidepressants such as mirtazapine, which have no significant effect on blood pressure, heart rate, intracardiac conduction, and heart rhythm, are recommended as drugs of choice for pharmacological therapy of depression in adult patients after heart transplantation [371, 372].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
Prescription of drugs metabolized by the cytochrome P-450 system (e.g., fluvoxamine, trazodone) to avoid drug interactions with cyclosporine** and tacrolimus** in adult patients should be avoided whenever possible [372].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
Tricyclic antidepressants (ATC: Non-selective monoamine reuptake inhibitors) (such as imipramine**, amitriptyline**) may have adverse side effects on the cardiovascular system and a cytotoxic effect on the myocardium (slowed intracardiac conduction, orthostatic hypotension, anticholinergic effects); therefore, they are recommended to be prescribed only to patients with severe depression refractory to other medications, in order to optimize therapy in adults [372].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
At each visit of an adult patient, it is recommended to assess their compliance with medication and lifestyle recommendations in order to evaluate the quality of treatment [372, 373].
Level of Recommendations B (Level of Evidence 2)Level of Evidence 2Level of Recommendations B (Level of Evidence 2).
It is recommended to assess compliance by any available means, such as taking a medical history, analyzing diary records, and gathering information from close relatives and attending medical staff to evaluate the quality of treatment [275, 371].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to evaluate adherence not only to immunosuppressants, but also to the entire drug therapy and non-pharmacological methods of adverse event prevention in order to optimize treatment [371, 373, 375].
GGR BLEL 3Grade of Recommendation B (Level of Evidence 3)
It is recommended to discuss any difficulties encountered in adhering to medication regimens with the patient in order to optimize treatment [375].
GGR BLEL 3Grade of Recommendation B (Level of Evidence 3)
It is recommended to manage and follow up the patient in close contact with their family members, involving them in educational programs in order to optimize treatment [375].
GGR BLEL 3Grade of Recommendation B (Level of Evidence 3)
It is recommended to encourage the patient's drive for independence and self-care in order to optimize treatment [371, 372, 375].
GGR BLEL 3Grade of Recommendation B (Level of Evidence 3)
Medical staff (physicians and nurses) providing local follow-up care to the patient are recommended to be trained in all aspects of managing patients after heart transplantation in order to optimize treatment [376].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to regularly screen the patient using available methods to detect signs of depression [374].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
4.4 Reproductive health in heart recipients
4.4.1 Recommendations for pregnancy planning and management in heart recipients
Pregnancy and delivery management strategies are developed taking into account the individual characteristics of the mother and the condition of the transplanted organ.
Pregnancy planning takes into account individual factors: the risk of graft rejection, the risk of infectious complications, the specifics of prescribed medications that may have toxic or teratogenic effects, and the characteristics of the transplanted organ. If a risk of an adverse outcome or complication of the upcoming pregnancy is identified, it is recommended to prevent it in order to prevent complications [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Pregnancy is not recommended to be planned during the first year after heart transplantation due to the increased risk of graft rejection [208, 378, 379, 436].
GCP CLE 4Grade of Recommendation C (Level of Evidence 4)
In pregnant heart transplant recipients, it is recommended to perform regular liver and kidney function monitoring, peripheral blood pressure measurement, and necessary diagnostic procedures to detect early signs of preeclampsia and gestational diabetes [208, 378, 379, 436].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Continuation of tacrolimus** and glucocorticoids is recommended for pregnant recipients, while mycophenolic acid** or mycophenolate mofetil** should be discontinued to minimize complications [378, 379]. Since the safety of tacrolimus** in pregnant women has not been sufficiently established, the drug should be used during pregnancy only if no safer alternative exists and only when the expected clinical benefit outweighs the potential risk to the fetus.
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
During pregnancy, it is recommended to carefully monitor blood levels of tacrolimus** or cyclosporine** due to the high pharmacokinetic variability of these drugs caused by pregnancy-related changes in plasma and interstitial fluid volume, as well as liver and kidney function, in order to minimize complications [378, 379].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Frequent examinations are recommended to detect potential graft rejection in pregnant women. X-ray-guided myocardial biopsy should be avoided. Ultrasound guidance is preferred for myocardial biopsy; if X-ray guidance is necessary, careful shielding of all body areas is required to protect the fetus from radiation [208, 378, 379, 436].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Data on the safety of azathioprine** as an alternative to mycophenolate mofetil** in pregnant women are contradictory. When prescribing either mycophenolate mofetil** or azathioprine**, both the risk of maternal graft rejection and the adverse effects of these drugs on the fetus must be considered [378, 379].
Breastfeeding is not recommended because the safety of currently used immunosuppressive therapies has not been established [379, 380].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
4.4.2 Recommendations for contraception in heart recipients
Progestogens and estrogens (G03AA Progestogens and estrogens, fixed combinations) are recommended to be prescribed after assessing risk factors for potential thrombotic complications (history of thromboembolism or in close relatives) in order to minimize complications [380, 381, 382].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to monitor blood drug levels in patients receiving combination immunosuppressive therapy, because fixed combinations of progestogens and estrogens (G03AA) exert an inhibitory effect on CYP3A4 [380, 381, 382].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Barrier contraceptive methods are recommended for all sexually active heart transplant recipients as a means of preventing sexually transmitted infections [380, 381, 382].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Intrauterine contraceptives are not recommended for use in patients after heart transplantation, especially nulliparous women, due to the potential risk of inflammatory and infectious complications and infertility [380, 381, 382].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In adult female patients after heart transplantation, the use of medroxyprogesterone** (suspension for intramuscular injection) is not recommended to avoid a decrease in bone mineral density [380, 381, 382].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
4.4.3 Recommendations for the treatment of erectile dysfunction in heart recipients
Selective inhibitors of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase-5 (ATC code C01CE Phosphodiesterase inhibitors) are recommended as medicinal products for the treatment of erectile dysfunction in adult patients after heart transplantation in order to improve quality of life. At the same time, it is recommended to avoid the combined prescription of phosphodiesterase inhibitors with organic nitrates (potentiation of the hypotensive effect) [383, 384].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
4.5 Recommendations for driving and operating vehicles in adult patients after heart transplantation
It is recommended to discuss the possibility of driving a vehicle with patients at the early postoperative stage in order to optimize therapy [387-389].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
The issue of the possibility of driving a vehicle is recommended to be resolved based on a neurological examination of the patient (tremor is excluded, posture stability is assessed, vision is examined) in order to optimize therapy [387, 388].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In patients with bradycardia, permission to drive a car is recommended if an artificial pacemaker is present in order to optimize therapy [389].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
5. Prevention and Dispensary Observation
Prevention of adverse events and follow-up care play an important role in ensuring a favorable long-term prognosis in heart transplant recipients.
The main causes of death after heart transplantation are acute graft rejection, heart failure, cardiac allograft vasculopathy, infections, renal failure, and oncological diseases. Graft rejection and infections are the leading causes of death during the first three years after heart transplantation, while malignancies and cardiac allograft vasculopathy predominate in the subsequent period.
Risk factors for adverse events during the first year after heart transplantation include pre-transplant factors, perioperative factors, donor-related risk factors, and postoperative factors. Studies conducted under the auspices of the Russian Transplant Society indicate that the most significant risk factors for adverse events during the first year after heart transplantation are the presence of comorbidities in the recipient in the pre-transplant period (renal failure, peripheral atherosclerosis), donor age, the presence of left ventricular myocardial hypertrophy or coronary artery atherosclerosis of the donor heart, duration of cardiac graft ischemia, repeat heart transplantation, the need for mechanical circulatory support in the perioperative period, recipient age (a U-shaped relationship is noted, with the lowest risk in 40-year-old recipients), recipient body mass index, blood bilirubin and creatinine levels, and the presence of pulmonary hypertension and infections.
Risk factors for adverse events within 5 years after heart transplantation, in addition to those listed above, include the number of transplantations performed by the transplant center, the development of post-transplantation diabetes mellitus, a history of pregnancies, and donor-recipient HLA and blood group incompatibility.
One of the most important modifiable risk factors for adverse events in heart transplant recipients is the adequacy of immunosuppressive therapy. The bioavailability of immunosuppressants, which determines the likelihood of both side effects and rejection, depends on many individual and external factors; therefore, rigorous monitoring of the side effects of immunosuppressive therapy is necessary.
5.1 Regular clinical examinations and consultations for patients after heart transplantation.
A follow-up appointment (examination, consultation) by a cardiologist is recommended annually for all patients after heart transplantation to improve patient survival and quality of life [521].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to perform planned myocardial biopsies once during the first hospitalization after heart transplantation; during subsequent hospitalizations, myocardial biopsies are performed according to indications in order to improve the quality of treatment [208, 236, 237].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
5.2 Monitoring the efficacy and safety of immunosuppressive therapy
In patients after heart transplantation, it is recommended to monitor the efficacy and safety of immunosuppressive therapy. If specific side effects develop, it is recommended to reduce the dose (or substitute) of medicinal products while maintaining an adequate level of immunosuppression in order to minimize side effects [262, 393, 394].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comment: The cytochrome CYP3A enzyme system and gastrointestinal P-glycoprotein play a key role in the metabolism of many immunosuppressants, such as cyclosporine**, tacrolimus**, #sirolimus, and everolimus**. Thus, medicinal products that alter cytochrome or P-glycoprotein activity can lead to an increase or decrease in the blood concentration of immunosuppressants.
5.3 Recommendations for the prevention of infective endocarditis after heart transplantation
There are no specific recommendations for the prevention of infective endocarditis in patients after heart transplantation. Given the high risk of developing acquired valvular regurgitation in such patients and the extremely unfavorable prognosis in the event of infective endocarditis, it is recommended that all dental procedures be performed against the background of prophylactic administration of systemic antibacterial drugs for the prevention of complications [188, 189, 191, 208, 436].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comment: Infective endocarditis develops rarely in patients after heart transplantation, but is accompanied by high mortality (up to 80%). The highest risk of developing infective endocarditis is observed in patients with valve defects. The main pathogens of infective endocarditis are Staphylococcus aureus and Aspergillus fumigatus. Staphylococcus aureus can be introduced via hemodialysis catheters, as well as during skin and subcutaneous tissue inflammation or contamination of the donor organ. Endocarditis caused by Aspergillus fumigatus often develops against the background of cytomegalovirus infection and may occur in the setting of disseminated aspergillosis, accompanied by Aspergillus endophthalmitis. Most commonly, the mitral and tricuspid valves are affected in endocarditis. Despite the lack of clinical evidence, antibiotic prophylaxis is indicated for all dental interventions to prevent infective endocarditis.
5.4 Recommendations for the prevention, diagnosis, and treatment of neoplasms in patients after heart transplantation
Adult patients after heart transplantation have a high risk of developing skin neoplasms, and therefore they are recommended to undergo preventive measures, including participation in educational programs and an annual preventive appointment (examination, consultation) with a dermatologist for the prevention of complications [400].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Patients after heart transplantation are recommended to undergo screening for the early detection and prevention of post-transplant lymphoproliferative disorders [400-402].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
In the long-term period after heart transplantation, it is recommended, whenever possible, to reduce the doses of immunosuppressants in adult patients to prevent complications [400].
GCP CLE 4Grade of Recommendation C (Level of Evidence 4)
5.5 Recommendations for the prevention, diagnosis, and treatment of renal failure in patients after heart transplantation
It is recommended that all patients after heart transplantation undergo an assessment of the glomerular filtration rate calculated by a formula, a general (clinical) urinalysis, and an assessment of the [urine albumin]/[serum creatinine] ratio at least once a year to prevent complications [404-407].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
Comment: Impaired renal excretory function is frequently detected in patients after heart transplantation and affects the prognosis. Renal excretory function is characterized by the glomerular filtration rate (GFR), calculated taking into account blood creatinine levels, weight, age, and gender of the patient. A decrease in renal excretory function is characterized by GFR values below 30 mL/min/1.73 m², and 5 years after heart transplantation, it is detected in approximately 10% of patients, accompanied by a fourfold increase in the risk of death.
Deterioration of renal excretory function, characterized by a 30-50% decrease in GFR, usually develops after the first 6 months following heart transplantation. Thereafter, the GFR value stabilizes or declines more slowly.
Risk factors for the development of renal failure after heart transplantation include:
«Traditional» risk factors for nephropathy:
arterial hypertension;
coronary and/or peripheral artery atherosclerosis;
diabetes mellitus;
advanced age;
female sex;
administration of high doses of tacrolimus** or cyclosporine**;
reduced renal function in the recipient prior to heart transplantation surgery.
Renal failure in patients after heart transplantation leads to the same consequences as in the general population: progression of coronary and peripheral atherosclerosis, arterial hypertension, anemia, and osteoporosis.
The most effective treatment method for severe renal failure in heart transplant recipients is kidney transplantation, after which the long-term prognosis is significantly better than on hemodialysis.
Heart transplant recipients with GFR <30 mL/min/1.73 m2, proteinuria >500 mg/day, or a rapid GFR decline >4 mL/min/1.73 m per year are recommended to undergo evaluation and management under the supervision of a nephrologist to correct metabolic disorders and other complications of renal failure. In cases of severe renal failure, renal transplantation should be considered [404-410].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In all adult heart transplant recipients with signs of renal failure, it is recommended to reduce the doses of tacrolimus** or cyclosporine** to the minimum level required to maintain adequate immunosuppression. In patients receiving azathioprine**, this may be achieved by replacing azathioprine** with mycophenolate mofetil** to prevent complications [264, 403–406].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In adult patients after heart transplantation, it is recommended to control glycemia, normalize blood pressure, and use ACE inhibitors or angiotensin II receptor blockers to improve life expectancy and quality of life. In patients with diabetes mellitus, the treatment strategy should comply with current guidelines for the prevention and management of diabetes mellitus. Target blood pressure levels should comply with adopted clinical guidelines [275].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
In heart transplant patients who develop severe renal failure, it is recommended to consider kidney transplantation, preferably from a living donor, to prevent complications [208, 404–406, 436].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
5.6 Recommendations for the prevention and treatment of arterial hypertension after heart transplantation
Adequate antihypertensive therapy is recommended for adult patients after heart transplantation, as it effectively reduces the risk of adverse cardiovascular events, including death, stroke, myocardial infarction, heart failure, and arrhythmias [411].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
Comment: The prevalence of arterial hypertension (AH) 5 years after heart transplantation can reach 95%. The development of AH following heart transplantation is primarily associated with the administration of tacrolimus** or cyclosporine**, with cyclosporine** being more strongly associated with the development of AH than tacrolimus**. Long-term glucocorticoid therapy is also accompanied by an increase in blood pressure (BP) levels. In addition to immunosuppressive therapy, the causes of AH after heart transplantation include impaired baroreflexes (increased activity) and progressive stiffening of the aorta and peripheral arteries.
Patients after heart transplantation more frequently exhibit so-called "masked arterial hypertension" (synonym: "isolated ambulatory hypertension"), characterized by the fact that BP levels measured in a doctor's office are lower than those measured at home or during 24-hour ambulatory blood pressure monitoring.
Most commonly, 24-hour ambulatory blood pressure monitoring in post-heart transplant patients reveals nighttime systolic BP elevation and persistently elevated diastolic BP levels.
It is recommended to perform regular peripheral blood pressure measurements and 24-hour ambulatory blood pressure monitoring in adult patients after heart transplantation to detect hypertension [411-412].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
5.7 Recommendations for the treatment of neurological complications after heart transplantation
Heart transplant recipients presenting with epileptiform seizures (syncope) are recommended to reduce the dose or discontinue cyclosporine** (while maintaining adequate immunosuppression) and correct hypomagnesemia (if detected) to prevent future seizures [414-415].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
If encephalopathy develops in the late post-transplant period, adult heart transplant patients are recommended a consultation with a neurologist and a brain computed tomography or brain magnetic resonance imaging scan to identify potential causes [414-415].
GCP CLE 4Grade of Recommendation C (Level of Evidence 4)
Upon the development of posterior reversible encephalopathy syndrome (PRES syndrome), it is recommended to reduce the dose of cyclosporine** or switch to alternative medicinal products [414-416].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
5.8 Guidelines for the Diagnosis, Prevention, and Treatment of Diabetes Mellitus in Heart Transplant Patients
Considering the high risk of developing diabetes mellitus, which negatively impacts prognosis and quality of life, it is recommended to include measures for the prevention and early diagnosis of this disease in the management program for heart transplant recipients; patients with diabetes mellitus must receive appropriate therapy to prevent complications [416, 417].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comment: Diabetes mellitus (DM) is quite common among heart transplant recipients (32% at 5 years post-transplant) and leads to the development and progression of cardiac allograft vasculopathy, increasing the risk of infectious complications and cardiac graft dysfunction.
Risk factors for DM in heart recipients:
Pre-transplant factors:
- hereditary predisposition to DM;
- impaired glucose tolerance;
- obesity and metabolic syndrome.
Post-transplant factors:
immunosuppressive therapy;
glucocorticoids;
tacrolimus** or cyclosporine** preparations (DM may develop more frequently with tacrolimus** than with cyclosporine**).
Recommended screening tests to detect diabetes mellitus in adult heart recipients include measuring blood glycated hemoglobin levels, fasting blood glucose levels, and performing an oral glucose tolerance test. The frequency of these measurements is determined by the patient's individual risk factors and the characteristics of the immunosuppressive therapy [417-419].
GCP CLE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to conduct drug therapy for diabetes mellitus in collaboration with an endocrinologist and in accordance with current guidelines for the management of diabetes mellitus to prevent complications [417-419].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
Non-pharmacological therapy for the prevention and treatment of diabetes mellitus in cardiac transplant recipients is recommended to include maintaining a normal body weight, adhering to a diet, and engaging in physical exercise to prevent complications [417-419].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
If risk factors are identified or a diagnosis of diabetes mellitus is established, it is recommended to review the immunosuppression regimen and, if possible, reduce the dosage or discontinue medications with diabetogenic effects, provided that such medication changes do not compromise the efficacy of immunosuppression aimed at preventing complications [417-419].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
Glucocorticoids and tacrolimus** or cyclosporine** reduce glucose tolerance and possess diabetogenic effects; therefore, in cardiac transplant recipients with diabetes mellitus and a high risk of developing diabetes mellitus, these medications are recommended to be prescribed in low doses or replaced with alternatives to prevent complications [417-419].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
Arterial hypertension and dyslipidemia significantly worsen the prognosis in patients with diabetes mellitus and increase the risk of complications; adequate antihypertensive therapy, HMG-CoA reductase inhibitors, and non-pharmacological prevention methods are recommended to reduce the risk of adverse events in adult heart transplant recipients with diabetes mellitus [397, 411, 417-419].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
Patients after heart transplantation who show elevated blood glucose or glycated hemoglobin levels on screening blood tests are recommended a consultation with an endocrinologist to prevent complications [417-419].
GCR CLOCE 5Grade of Recommendation C (Level of Evidence 5)
5.9 Recommendations for the prevention of osteoporosis in heart transplantation
In all adult patients awaiting heart transplantation, it is recommended to perform initial screening/evaluation to identify existing bone tissue disorders. It is advisable to perform X-ray densitometry to assess bone mineral density in the lumbar spine and femoral neck [420-427].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
Comment: Osteoporosis is frequently diagnosed in patients awaiting heart transfusion. Risk factors for osteoporosis in patients with heart failure awaiting heart transfusion include heart failure-related cachexia, reduced mobility/physical activity, low plasma 25-hydroxyvitamin D levels, hypogonadism, prolonged administration of sodium heparin**, prolonged diuretic therapy, renal impairment, and secondary hyperparathyroidism.
Detection of decreased bone mineral density or vertebral compression fracture warrants a thorough clinical evaluation to identify potential causes. Treatment of osteoporosis in adults is recommended to be initiated before heart transfusion. Bisphosphonates are the most effective medications for treating osteoporosis in adults to prevent complications [422, 423].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
Comment: Bisphosphonates are first-line medications for the treatment of postmenopausal osteoporosis, osteoporosis in men, and glucocorticoid-induced osteoporosis. In these patients, bisphosphonate therapy significantly increases bone mineral density and reduces the risk of fractures.
It is recommended that all adult patients awaiting heart transfusion and heart transplant recipients consume adequate amounts of calcium and vitamin D supplements and their analogs to maintain blood 25-hydroxyvitamin D concentrations above 30 ng/mL or 75 nmol/L) [422, 423, 426].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
It is recommended to prescribe biofeedback physical training to adult patients following heart transfusion based on hemodynamic parameters (heart rate, blood pressure) to prevent complications [420, 422, 423].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to administer prophylactic bisphosphonate therapy for at least the first year post-transplant in all adult patients following heart transfusion to prevent complications [422, 424, 426].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
It is recommended to use bisphosphonate medications in combination with calcium supplements and vitamin D supplements and their analogs to prevent bone loss and reduce the risk of fractures in adult patients following heart transfusion to prevent complications [208, 422, 423, 426].
GPR BLEL 2Grade of Recommendation B (Level of Evidence 2)
Vertical spine X-ray is recommended for all adult patients awaiting heart transfusion to detect traumatic extremity bone fractures and vertebral compression fractures [420].
GCP CLE 4Grade of Recommendation C (Level of Evidence 4)
X-ray densitometry of bone mineral density is recommended for all adult heart transplant recipients one year post-transplant. Subsequent annual bone mineral density assessments are indicated for patients receiving glucocorticoids, those with signs of osteoporosis, and those taking bisphosphonates. Thereafter, X-ray densitometry should be repeated every two to three years to prevent complications [420, 422].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
It is recommended to prescribe vitamin D medications and their analogs as first-line therapy in adult patients with reduced bone mineral density. When these medications are prescribed, regular testing of total blood calcium and urinary calcium levels (calciemia, calciuria — adverse effects of this drug class) is indicated to prevent complications [208, 422-426].
GCR CLOCE 4Grade of Recommendation C (Level of Evidence 4)
6. Organization of Medical Care
Patients following heart transfusion must remain under the continuous supervision of the transplant center and receive necessary medical care locally.
6.1 Indications for emergency hospitalization
The primary reasons for emergency hospitalization are life-threatening conditions or the detection of clinical signs that do not rule out their development. It should be noted that both rejection and ischemia of the cardiac graft in the early stages may lack clear clinical manifestations or present with nonspecific symptoms such as "general malaise", fatigue, weakness, nausea, vomiting, and fever. The danger of such conditions lies in the rapid, lightning-fast development of acute heart failure and patient death.
Indications for emergency hospitalization:
- signs of cardiac graft rejection;
- signs of acute or chronic cardiac graft ischemia;
- development of arterial hypotension or a decrease in systolic blood pressure levels by more than 20 mm Hg compared to baseline levels;
- an increase or decrease in average heart rate by more than 10 min-1;
- a rise in temperature up to 38 °C within 24 hours;
- weight loss of more than 1.0 kg per week or 2–2.5 kg over an unspecified period of time;
- the need for any surgical interventions;
- complaints of dyspnea regardless of the conditions of onset and relief;
- occurrence of any respiratory tract diseases, including acute respiratory viral infections;
- onset of chest pain;
- a decrease in forced expiratory volume in 1 second by more than 10%;
- "nonspecific" gastrointestinal symptoms: abdominal pain, nausea, vomiting, diarrhea;
- clinical signs of cerebrovascular accident, syncope, or altered cognitive status.
6.2 Indications for Discharge from the Inpatient Facility
- Absence of indications for emergency or urgent invasive intervention or examination;
- Low risk of adverse events.
7. Additional Information
The specifics of managing patients after heart transfusion are determined by a number of specific factors, which include the interaction between the recipient's body and the cardiac graft, the need for lifelong immunosuppressive therapy, the course of the underlying disease that led to end-stage heart failure in the pre-transplant period, as well as specific aspects of psychological, physical, and social adaptation. At the same time, one must also account for the physiology of the transplanted heart as a denervated organ, namely the absence of pain during myocardial ischemia, the absence of vagal influence, and the dependence of left ventricular contractility on incoming blood volume (preload).
The long-term prognosis in patients after heart transfusion is primarily determined by the specifics of the interaction between the recipient's body and the transplanted organ, manifested as graft rejection. Being highest in the first months and decreasing a year or more after transplantation surgery, the risk of heart graft rejection persists for life, necessitating continuous immunosuppressive therapy. The side effects of immunosuppressive therapy negatively impact prognosis and quality of life. The most significant adverse effects include the development of malignancies, the risk of infectious complications, nephropathy, diabetes mellitus, arterial hypertension, neurological disorders, osteoporosis, and reproductive health effects, among others. To maintain a balance between adequate immunosuppression and the prevention of side effects, careful monitoring of immunosuppressive therapy is required, including the measurement of drug concentrations in the blood. In patients receiving immunosuppressive therapy, drug interactions must be considered, the danger of which lies in both the likelihood of adverse effects and the reduction of immunosuppressive efficacy. Therefore, any changes in medication prescriptions must be coordinated with the patient's affiliated transplant center.
Criteria for Evaluating the Quality of Medical Care
Criteria for evaluating the quality of medical care for heart transplant recipients and heart transplant recipients with clinical signs of cardiac graft rejection/dysfunction are presented in Tables 3 and 4.
Table 3. Criteria for evaluating the quality of medical care for heart transplant recipients
No. | Criterion | Performance evaluation |
|---|---|---|
1. | Induction immunosuppressive therapy was performed | Yes/No |
2 | Blood level testing of medications (immunosuppressants) was performed | Yes/No |
3. | Echocardiography was performed in all potential heart recipients | Yes/No |
4. | Coronary angiography was performed in patients with cardiac graft coronary vasculopathy | Yes/No |
5. | Myocardial biopsy was performed between 3 and 12 months after heart transfusion and/or upon suspicion of acute graft rejection | Yes/No |
Table 4. Criteria for evaluating the quality of medical care for heart transplant recipients with clinical signs of cardiac graft rejection/dysfunction
No. | Criterion | Performance evaluation |
|---|---|---|
1. | Blood level testing of medications (immunosuppressants) was performed | Yes/No |
2. | Echocardiography performed | Yes/No |
3. | Coronary angiography was performed in patients with cardiac graft coronary vasculopathy | Yes/No |
4. | Myocardial biopsy was performed upon suspicion of acute graft rejection | Yes/No |
5. | Intravenous glucocorticoid pulse therapy was performed in the presence of clinical symptoms of acute cellular rejection regardless of rejection severity | Yes/No |
References
Show references
Maddox T.M., Januzzi J.L., Allen L.A., et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021; 77 (6): 772810.
McDonagh T.A., Metra M., Adamo M., et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2021; 42 (36): 3599-3726.
Gautier S.V., Shevchenko A.O., Kormer A.Ya., Poptsov V.N., Saitgareev R.Sh., Shumakov D.V., Zakharevich V.M. Three decades of heart transplantation at the Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs: long-term results. Russian Journal of Transplantology and Artificial Organs. 2015;15(2):70-73. (In Russ.)
Lund et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report—2015. J Heart Lung Transplant 2015;34:1244-1254.
Gautier S.V., Shevchenko A.O., Poptsov V.N., Saitgareev R.Sh., Zakharevich V.M., Shumakov D.V., Akopov G.A. Experience of 800 heart transplantations at the Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):52-53. (In Russ.)
Gautier SV, Shevchenko AO, et al. Thirty-Year Dynamics of Survival among Heart Recipients: A Single Center Russian Experience. Transplantation. 2018; 102: S827. DOI: 10.1097/01.tp.0000543875.50643.83.
Galyavich A.S., Tereshchenko S.N., Uskach T.M., Ageev F.T., Aronov D.M., Arutyunov G.P., Begrambekova Yu.L., Belenkov Yu.N., Boytsov S.A., et al. Chronic heart failure. Clinical guidelines 2024. Russian Journal of Cardiology. 2024;29(11):6162. https://doi.org/10.15829/1560-4071-2024-6162. EDN: WKIDLJ (In Russ.)
Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates— 2006. J Heart Lung Transplant 2006;25:1024-42.
Gautier S.V., Shevchenko A.O., Kormer A.Ya., Poptsov V.N., Shevchenko O.P. Prospects for improving long-term outcomes of heart transplantation. Russian Journal of Transplantology and Artificial Organs. 2014;16(3):23-30. (In Russ.)
Gautier S.V., Zakharevich V.M., Khalilulin T.A., Shevchenko A.O., Poptsov V.N., Ahmadzai R.L., Golts A.M., Zakiryanov A.R., Koloskova N.N., Zakharevich N.Yu., Nikitina E.A., Pozdnyakov O.A., Kiryakov K.S. Heart transplantation as a radical method for restoring the quality of life in recipients with end-stage heart failure. Russian Journal of Transplantology and Artificial Organs. 2019;21(2):70-73. (In Russ.)
Levy WC, Mozaffarian D, Linker DT, et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 2006;113:1424-33.
Goda A, Williams P, Mancini D, Lund LH. Selecting patients for heart transplantation: comparison of the Heart Failure Survival Score (HFSS) and the Seattle heart failure model (SHFM). J Heart Lung Transplant 2011;30:1236-43.
Levy WC, Mozaffarian D, Linker DT, Farrar DJ, Miller LW. Can the Seattle heart failure model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy? J Heart Lung Transplant 2009;28:231-6.
Kalogeropoulos AP, Georgiopoulou VV, Giamouzis G, et al. Utility of the Seattle Heart Failure Model in patients with advanced heart failure. J Am Coll Cardiol 2009;53:334-42.
Herz M I. The Registry of the International Society for Heart and Lung TransplantationIntroduction to the 2012 annual reports: new leadership, same vision. J Heart Lung Transplant. 2012;31:1045-1051.
Arias M, Rush D N, Wiebe C, Gibson I W, Blydt-Hansen T D, Nickerson P W. et al. Antibody-mediated rejection: analyzing the risk, proposing solutions. Transplantation. 2014;98:3-21.[(Suppl 3)].
Mehra M R. Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy. Am J Transplant. 2006; 6:1248-1256.
Mitchell R N, Libby P. Vascular remodeling in transplant vasculopathy. Circ Res. 2007;100:967-978.
Tuzcu E M, Kapadia S R, Sachar R, Ziada K M, Crowe T D, Feng J. et al. Intravascular ultrasound evidence of angiographically silent progression in coronary atherosclerosis predicts long-term morbidity and mortality after cardiac transplantation. J Am Coll Cardiol. 2005;45:1538-1542.
Goda A, Williams P, Mancini D, Lund LH. Selecting patients for heart transplantation: comparison of the Heart Failure Survival Score (HFSS) and the Seattle heart failure model (SHFM). J Heart Lung Transplant 2011; 30: 1236-43.
Patel P., Glumova A., LaPorte K., Mahle W.T., Deshpande S.R. High Pulmonary Vascular Resistance in Pediatric Heart Transplant Patients and Role of Sildenafil. The Journal of Heart and Lung Transplantation, Vol. 36, Issue 4, S270.
Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022;43:3618-731. https://doi.org/10.1093/eurheartj/ehac237. Published correction appears in Eur Heart J. 2023 Apr 17;44:1312.
Auler Junior JO, Carmona MJ, Bocchi EA, et al. Low doses of inhaled nitric oxide in heart transplant recipients. J Heart Lung Transplant 1996;15:443-50.
De Santo LS, Mastroianni C, Romano G, et al. Role of sildenafil in acute posttransplant right ventricular dysfunction: successful experience in 13 consecutive patients. Transplant Proc 2008;40:2015-8.
Mikus E, Stepanenko A, Krabatsch T, et al. Reversibility of fixed pulmonary hypertension in left ventricular assist device support recipients. Eur J Cardiothorac Surg 2011; 40: 971-7.
Kutty RS, Parameshwar J, Lewis C, et al. Use of centrifugal left ventricular assist device as a bridge to candidacy in severe heart failure with secondary pulmonary hypertension. Eur J Cardiothorac Surg 2013; 43:1237-42.
Poptsov V.N., Spirina E.A., Ukhrenkov S.G., Aliev E.Z., Khatutsky V.M., Dogonasheva A.A. Mechanical circulatory support in early cardiac allograft dysfunction. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):58. (In Russ.)
Gautier S.V., Poptsov V.N., Zakharevich V.M., Shevchenko A.O., Spirina E.A., Ukhrenkov S.G., Masyutin S.A., Aliev E.Z., Voronkov V.Yu., Chibisov N.S., Ustin S.Yu., Bondarenko D.M. Five-year experience with peripheral veno-arterial extracorporeal membrane oxygenation as a method of mechanical circulatory support in potential heart recipients. Russian Journal of Transplantology and Artificial Organs. 2016;18(4):16-25. (In Russ.)
Poptsov V.N., Spirina E.A., Ukhrenkov S.G., Bondarenko D.M., Dogonasheva A.A., Aliev E.Z. Temporary mechanical circulatory support in potential heart recipients. Russian Journal of Transplantology and Artificial Organs. 2017;19(4):113-123. (In Russ.)
Gautier S.V., Poptsov V.N., Spirina E.A., Saitgareev R.Sh., Zakharevich V.M., Akopov G.A., Shumakov D.V., Zakiryanov A.R., Khalilulin T.A., Golts A.M., Shevchenko A.O., Koloskova N.N. Comparative analysis of factors potentially affecting heart transplantation outcomes in previously open-heart operated and non-operated patient groups. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):55-56. (In Russ.)
Gautier S.V., Poptsov V.N., Saitgareev R.Sh., Shumakov D.V., Akopov G.A., Tarabarko N.N., Aniskevich G.V. Heart transplantation after surgical correction of cardiac allograft valvular pathology. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):65-66. (In Russ.)
Poptsov V.N., Spirina E.A., Masyutin S.A., Pchelnikov V.V., Ukhrenkov S.G., Aliev E.Z., Ustin S.Yu., Khatutsky V.M., Dogonasheva A.A. Perioperative period in heart transplantation from donors aged 55 years and older. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):62. (In Russ.)
Taylor DO, Edwards LB, Boucek MM, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplant report — 2007. J Heart Lung Transplant 2007;26:769.
Taylor DO, Stehlik J, Edwards LB, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-sixth official adult heart transplant report — 2009. J Heart Lung Transplant 2009;28:1007.
Leprince P, Aubert S, Bonnet N, et al. Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure. Transplant Proc 2005;37:2879.
Taylor DO, Edwards LB, Boucek MM, Trulock EP, Waltz DA, Keck BM, et al. Registry of the International Society for Heart and Lung Transplantation: Twenty-third official adult heart transplantation report-2006. JHLTX 2006; 25:869-79.
Gardner RS, McDanagh TA, MacDonald M, Dargie HJ, Murday AJ, Petrie MC. Who needs a heart transplant? Eur Heart J 2006; 27:770-2.
Hunt SA, Kouretas PC, Balsam LB, Robbins RC. Heart transplantation. In Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald’s Heart Disease. 7 th edition. Elsevier Saunders 2005.
Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344 :1651-8.
Lewis EF, Tsang SW, Fang JC, et al. Frequency and impact of delayed decisions regarding heart transplantation on long-term outcomes in patients with advanced heart failure. J Am Coll Cardiol 2004; 43:794-802.
Feldman D. et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support. The Journal of Heart and Lung Transplantation, 2013 Vol. 32, Issue 2, p157-187.
Itkin G.P., Poptsov V.N. Mechanisms of right ventricular failure under left ventricular assist device support and methods of biventricular bypass. Russian Journal of Transplantology and Artificial Organs. 2013;10(4):126-135. (In Russ.)
Kirklin J.K., Naftel D.C., Pagani F.D., et al. Seventh INTERMACS annual report: 15,000 patients and counting. J. Heart Lung Transplant. 2015; 34: 1495- 1504.
Gautier S.V., Itkin G.P., Shemakin S.Yu., Saitgareev R.Sh., Poptsov V.N., Zakharevich V.M., Akopov G.A., Kormer A.Ya., Khalilulin T.A., Shevchenko O.P., Nevzorov A.M., Filatov I.A., Selishchev S.V. First clinical experience with a domestically produced assist device based on an implantable axial pump for two-stage heart transplantation. Russian Journal of Transplantology and Artificial Organs. 2013;10(3):92-101. (In Russ.)
Taylor Clare J, Ordonez-Mena Jose M, Roalfe Andrea K, Lay-Flurrie Sarah, Jones Nicholas R, Marshall Tom et al. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study BMJ 2019; 364 :l223
Brown KN, Kanmanthareddy A. Heart Transplantation Patient Selection. [Updated 2020 Oct 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537090/.
Ravichandran AK, Cowger J. Left ventricular assist device patient selection: do risk scores help?. J Thorac Dis. 2015;7(12):2080-2087. doi:10.3978/j.issn.2072-1439.2015.11.02
S. Li, et al.Validity of the Seattle Heart Failure Model after heart failure hospitalization. ESC Heart Fail., 6 (3) (2019), pp. 509-515.
Gorodeski EZ, Chu EC, Chow CH, Levy WC, Hsich E, Starling RC. Application of the Seattle Heart Failure Model in ambulatory patients presented to an advanced heart failure therapeutics committee. Circ Heart Fail 2010;3:706-14.
Pamboukian SV, Tallaj JA, Brown RN, et al. Comparison of observed survival with assist device versus predicted survival without device using the Seattle heart failure model. ASAIO J 2012;58:93-7.
Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997;95:2660-7.
Parikh MN, Lund LH, Goda A, Mancini D. Usefulness of peak exercise oxygen consumption and the heart failure survival score to predict survival in patients 465 years of age with heart failure. Am J Cardiol 2009;103:998-1002.
Goda A, Lund LH, Mancini DM. Comparison across races of peak oxygen consumption and heart failure survival score for selection for cardiac transplantation. Am J Cardiol 2010;105:1439-44.
Green P, Lund LH, Mancini D. Comparison of peak exercise oxygen consumption and the Heart Failure Survival Score for predicting prognosis in women versus men. Am J Cardiol 2007;99:399-403.
Lund LH, Aaronson KD, Mancini DM. Validation of peak exercise oxygen consumption and the Heart Failure Survival Score for serial risk stratification in advanced heart failure. Am J Cardiol 2005;95:734-41.
de la Rosa AL, Singer-Englar T, Tompkins RO, Patel JK, Kobashigawa JA, Kittleson MM. Advanced heart failure and heart transplantation in adult congenital heart disease in the current era. Clin Transplant 2021;35:e14451. https://doi.org/10.1111/ctr.14451.
Stevenson LW, Miller LW, Desvigne-Nickens P, et al. Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). Circulation 2004;110:975-81.
Hershberger RE, Nauman D, Walker TL, Dutton D, Burgess D. Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure. J Card Fail 2003;9:180-7.
Fellahi J.L. et al. Perioperative Use of Dobutamine in Cardiac Surgery and Adverse Cardiac Outcome: Propensity-adjusted Analyses. Anesthesiology. 2008; 108: 979-987.
Rao V, Oz MC, Flannery MA, Catanese KA, Argenziano M, Naka Y. Revised screening scale to predict survival after insertion of a left ventricular assist device. J Thorac Cardiovasc Surg 2003;125:855-62.
Lietz K, Long JW, Kfoury AG, et al. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation 2007;116:497-505.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818-29.
Schaffer JM, Allen JG, Weiss ES, et al. Evaluation of risk indices in continuous-flow left ventricular assist device patients. Ann Thorac Surg 2009;88:1889-96.
Teuteberg J, Ewald G, Adamson R, et al. Application of the destination therapy risk score to HeartMate II clinical trial data [abstract] [manuscript in press, JACC]. J Heart Lung Transplant 2011;30:S31.
Boyle AJ, Ascheim DD, Russo MJ, et al. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification. J Heart Lung Transplant 2011;30:402-7.
Cowger J, Sundareswaran K, Rogers J, et al. The HeartMate II risk score: Predicting survival in candidates for left ventricular assist device support [abstract]. J Heart Lung Transplant 2011;30:S31
S.G. Al Kindi, M. Farhoud, et al. Left ventricular assist devices or inotropes for decreasing pulmonary vascular resistance in patients with pulmonary hypertension listed for heart transplantation J. Card. Fail., 23 (2017), pp. 209-215.
Jennifer Cowger et al. 70 The HeartMate II Risk Score: Predicting Survival in Candidates for Left Ventricular Assist Device Support. April 2011The Journal of Heart and Lung Transplantation 30(4).
Pagani FD, Miller LW, Russell SD, et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol 2009; 54:312-21.
Goodwin M, Nemeh HW, Borgi J, Paone G, Morgan JA. Resolution of Mitral Regurgitation With Left Ventricular Assist Device Support Ann Thorac Surg. 2017 Sep;104(3):811-818.
Schweiger M1, Stepanenko A, Vierecke J, Drews T, Potapov E, Hetzer R, Krabatsch T. Biological mitral valve prosthesis in a patient supported with a permanent left ventricle assist device. ASAIO J. 2011 Nov-Dec;57(6):550-2.
Choi JH, Luc JGY, Moncho Escriva E, Phan K, Rizvi SSA, Patel S, Entwistle JW, Morris RJ, Massey HT, Tchantchaleishvili V. Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic Review and Meta-Analysis Artif Organs. 2018 Dec;42(12):1139- 1147
Oezpeker C, Zittermann A, Paluszkiewicz L, Piran M, Puehler T, Sayin AO, Ensminger S, Milting H, Morshuis M, Gummert JF. Tricuspid valve repair in patients with left-ventricular assist device implants and tricuspid valve regurgitation: propensity score-adjusted analysis of clinical outcome. Interact Cardiovasc Thorac Surg. 2015 Dec;21(6):741-7
Lahpor JR, de Jonge N, van Swieten HA, Wesenhagen H, Klopping C, Geertman JH, Oosterom A, Rodermans B, Kirkels JH.Left ventricular assist device as bridge to transplantation in patients with end-stage heart failure: Eight-year experience with the implantable HeartMate LVAS. Neth Heart J. 2002 Jun;10(6):267-271
Morgan JA, Tsiouris A, Nemeh HW, Hodari A, Karam J, Brewer RJ, Paone G. Impact of concomitant cardiac procedures performed during implantation of long-term left ventricular assist devices. J Heart Lung Transplant. 2013 Dec;32(12):1255-61
Kittipibul V, Rattanawong P, Kewcharoen J, Chongsathidkiet P, Vutthikraivit W, Kanjanahattakij N. Atrial Fibrillation Is Not Associated With Thromboembolism in Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis. ASAIO J. 2018 Jun 5
Johnsson P, Algotsson L, Ryding E, Stahl E, Messeter K. Cardiopulmonary perfusion and cerebral blood flow in bilateral carotid artery disease. Ann Thorac Surg 1991;51:579-84.
Selim M. Angioplasty and stenting of asymptomatic carotid stenosis before cardiac surgery: more study is needed. Arch Neurol 2008; 65:1672-4.
Lazar HL, Menzoian JO. Coronary artery bypass grafting in patients with cerebrovascular disease. Ann Thorac Surg 1998;66:968-74.
Kato TS, Schulze PC, Yang J, et al. Pre-operative and post-operative risk factors associated with neurologic complications in patients with advanced heart failure supported by a left ventricular assist device. J Heart Lung Transplant 2012;31:1-8.
Wadia Y, Etheridge W, Smart F, Wood RP, Frazier OH. Pathophysiology of hepatic dysfunction and intrahepatic cholestasis in heart failure and after left ventricular assist device support. J Heart Lung Transplant 2005;24:361-70.
Levy JH, Winkler AM. Heparin-induced thrombocytopenia and cardiac surgery. Curr Opin Anaesthesiol 2010;23:74-9.
Morel-Kopp MC, Aboud M, Tan CW, Kulathilake C, Ward C. Whole blood impedance aggregometry detects heparin-induced thrombocytopenia antibodies. Thromb Res 2010;125:e234-9.
Warkentin TE, Greinacher A, Koster A. Heparin-induced thrombocytopenia in patients with ventricular assist devices: are new prevention strategies required? Ann Thorac Surg 2009;87:1633-40.
Zucker MJ, Sabnani I, Baran DA, Balasubramanian S, Camacho M. Cardiac transplantation and/or mechanical circulatory support device placement using heparin anticoagulation in the presence of acute heparin-induced thrombocytopenia. J Heart Lung Transplant 2010;29:53-60.
Butler J, Howser R, Portner PM, Pierson RN 3rd. Diabetes and outcomes after left ventricular assist device placement. J Card Fail 2005;11:510-5.
Topkara VK, Dang NC, Martens TP, et al. Effect of diabetes on short- and long-term outcomes after left ventricular assist device implantation. J Heart Lung Transplant 2005;24:2048-53.
Uriel N, Naka Y, Colombo PC, et al. Improved diabetic control in advanced heart failure patients treated with left ventricular assist devices. Eur J Heart Fail 2011;13:195-9.
Kolesar A, Sabol F, Luczy J, Bajmoczi M. Use of left ventricle assist device in a pregnant woman with acute aortic and coronary dissections. Interact Cardiovasc Thorac Surg 2010;11:194-5.
LaRue S, Shanks A, Wang IW, Ewald G, Anderson D, Joseph S. Left ventricular assist device in pregnancy. Obstet Gynecol 2011;118: 426-8.
Oles D, Berryessa R, Campbell K, Bhatti MA. Emergency redo mitral valve replacement in a 27-year-old pregnant female with a clotted prosthetic mitral valve, preoperative fetal demise and postoperative ventricular assist device: a case report. Perfusion 2001;16:159-64. The Journal of Heart and Lung Transplantation, Vol 32, No 2, February 2013 180
Sims DB, Vink J, Uriel N, et al. A successful pregnancy during mechanical circulatory device support. J Heart Lung Transplant 2011;30:1065
Dew MA, DiMartini AF, Steel J, et al. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl 2008;14:159-72
Holman WL, Kormos RL, Naftel DC, et al. Predictors of death and transplant in patients with a mechanical circulatory support device: a multi-institutional study. J Heart Lung Transplant 2009;28:44-50.
Adamson RM, Stahovich M, Chillcott S, et al. Clinical strategies and outcomes in advanced heart failure patients older than 70 years of age receiving the HeartMate II left ventricular assist device: a community hospital experience. J Am Coll Cardiol 2011;57:2487-95.
Park SJ, Milano CA, Tatooles AJ, et al. Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy. Circ Heart Fail 2012;5:241-8
Raymond AL, Kfoury AG, Bishop CJ, et al. Obesity and left ventricular assist device driveline exit site infection. ASAIO J 2010;56:57-60.
Zahr F, Genovese E, Mathier M, et al. Obese patients and mechanical circulatory support: weight loss, adverse events, and outcomes. Ann Thorac Surg 2011;92:1420-6.
Brewer RJ, Lanfear DE, Sai-Sudhakar CB, et al. Extremes of body mass index do not impact mid-term survival after continuous-flow left ventricular assist device implantation. J Heart Lung Transplant 2012;31:167-72
Gelow JM, Desai AS, Hochberg CP, Glickman JN, Givertz MM, Fang JC. Clinical predictors of hepatic fibrosis in chronic advanced heart failure. Circ Heart Fail 2010;3:59-64.
Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 2010;121:214-20.
Concha PM, Mertz KV. [Perioperative risk among patients with cirrhosis]. Rev Med Chil 2010;138:1165-71.
Modi A, Vohra HA, Barlow CW. Do patients with liver cirrhosis undergoing cardiac surgery have acceptable outcomes? Interact Cardiovasc Thorac Surg 2010;11:630-4.
Frazier OH, Rose EA, Oz MC, et al. Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg 2001; 122:1186-95.
Khan MA, Hussain SF. Pre-operative pulmonary evaluation. J Ayub Med Coll Abbottabad 2005;17:82-6.
Wright DJ, Khan KM, Gossage EM, Saltissi S. Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test. Clin Rehabil 2001;15:119-24.
Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999;340:937-44.
Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006;144:581-95.
Miller LW, Lietz K. Candidate selection for long-term left ventricular assist device therapy for refractory heart failure. J Heart Lung Transplant 2006;25:756-64.
Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J 2005;26:153-61.
Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948-68.
Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999;27:340-7.
Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. Coronary artery bypass grafting in patients with COPD. Chest 1998; 113:878-82.
Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA Jr.. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 2004;199:531-7.
Bapoje SR, Whitaker JF, Schulz T, Chu ES, Albert RK. Preoperative evaluation of the patient with pulmonary disease. Chest 2007; 132:1637-45.
Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000;232:242-53.
Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-50.
Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest 1993;104:1445-51.
Culver BH. How should the lower limit of the normal range be defined? Respir Care 2012;57:136-45.
Sandner SE, Zimpfer D, Zrunek P, et al. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg 2009;87:1072-8.
Butler J, Geisberg C, Howser R, et al. Relationship between renal function and left ventricular assist device use. Ann Thorac Surg 2006;81:1745-51.
Topkara VK, Dang NC, Barili F, et al. Predictors and outcomes of continuous veno- venous hemodialysis use after implantation of a left ventricular assist device. J Heart Lung Transplant 2006;25:404-8.
Ootaki C, Yamashita M, Ootaki Y, et al. Reduced pulsatility induces periarteritis in kidney: role of the local renin-angiotensin system. J Thorac Cardiovasc Surg 2008;136:150-8.
Radovancevic B, Vrtovec B, de KE, Radovancevic R, Gregoric ID, Frazier OH. Endorgan function in patients on long-term circulatory support with continuous- or pulsatile-flow assist devices. J Heart Lung Transplant 2007;26:815-8.
Letsou GV, Myers TJ, Gregoric ID, et al. Continuous axial-flow left ventricular assist device (Jarvik 2000) maintains kidney and liver perfusion for up to 6 months. Ann Thorac Surg 2003;76:1167-70.
Russell SD, Rogers JG, Milano CA, et al. Renal and hepatic function improve in advanced heart failure patients during continuous-flow support with the HeartMate II left ventricular assist device. Circulation 2009;120:2352-7.
Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 2007;357:885-96.
Slaughter MS, Pagani FD, Rogers JG, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant 2010;29:S1-39.
Singh M, Shullo M, Kormos RL, et al. Impact of renal function before mechanical circulatory support on posttransplant renal outcomes. Ann Thorac Surg 2011;91:1348-54.
Cupples S, Dew MA, Grady KL, et al. Report of the Psychosocial Outcomes Workgroup of the Nursing and Social Sciences Council of the International Society for Heart and Lung Transplantation: present status of research on psychosocial outcomes in cardiothoracic transplantation: review and recommendations for the field. J Heart Lung Transplant 2006;25:716-25.
Eshelman AK, Mason S, Nemeh H, Williams C. LVAD destination therapy: applying what we know about psychiatric evaluation and management from cardiac failure and transplant. Heart Fail Rev 2009;14:21-8.
Levenson JL, Olbrisch ME. Psychosocial evaluation of organ transplant candidates. A comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics 1993;34:314-23.
Olbrisch ME, Benedict SM, Ashe K, Levenson JL. Psychological assessment and care of organ transplant patients. J Consult Clin Psychol 2002;70:771-83.
Olbrisch ME, Levenson JL. Psychosocial assessment of organ transplant candidates. Current status of methodological and philosophical issues. Psychosomatics 1995;36:236-43.
De Geest S, Abraham I, Moons P, et al. Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients. J Heart Lung Transplant 1998;17:854-63.
De Geest S, Dobbels F, Martin S, Willems K, Vanhaecke J. Clinical risk associated with appointment noncompliance in heart transplant recipients. Prog Transplant 2000;10:162-8.
De Geest S, Dobbels F, Fluri C, Paris W, Troosters T. Adherence to the therapeutic regimen in heart, lung, and heart-lung transplant recipients. J Cardiovasc Nurs 2005;20:S88-98.
Dew MA, Roth LH, Thompson ME, Kormos RL, Griffith BP. Medical compliance and its predictors in the first year after heart transplantation. J Heart Lung Transplant 1996;15:631- 45.
Nagele H, Kalmar P, Rodiger W, Stubbe HM. Smoking after heart transplantation: an underestimated hazard? Eur J Cardiothorac Surg 1997;12:70-4
Pagani FD, Lynch W, Swaniker F, et al. Extracorporeal life support to left ventricular assist device bridge to heart transplant: A strategy to optimize survival and resource utilization. Circulation 1999;100: II206-10.
Aziz TA, Singh G, Popjes E, et al. Initial experience with CentriMag extracorporal membrane oxygenation for support of critically ill patients with refractory cardiogenic shock. J Heart Lung Transplant 2010;29:66-71.
Bagai J, Webb D, Kasasbeh E, et al. Efficacy and safety of percutaneous life support during high-risk percutaneous coronary intervention, refractory cardiogenic shock and inlaboratory cardiopulmonary arrest. J Invasive Cardiol 2011;23:141-7.
Cleveland JC Jr, Naftel DC, Reece TB, et al. Survival after biventricular assist device implantation: an analysis of the Interagency Registry for Mechanically Assisted Circulatory Support database. J Heart Lung Transplant 2011;30:862-9.
Krabatsch T, Schweiger M, Stepanenko A, et al. Mechanical circulatory support-results, developments and trends. J Cardiovasc Transl Res 2011;4:332-9.
Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intraaortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2005;26:1276-83.
Engstrom AE, Cocchieri R, Driessen AH, et al. The Impella 2.5 and 5.0 devices for ST- elevation myocardial infarction patients presenting with severe and profound cardiogenic shock: the Academic Medical Center intensive care unit experience. Crit Care Med 2011;39:2072-9.
Koeckert MS, Jorde UP, Naka Y, Moses JW, Takayama H, Impella LP. 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support. J Card Surg 2011;26:666-8.
Meyns B, Dens J, Sergeant P, Herijgers P, Daenen W, Flameng W. Initial experiences with the Impella device in patients with cardiogenic shock—Impella support for cardiogenic shock. Thorac Cardiovasc Surg 2003;51:312-7.
Siegenthaler MP, Brehm K, Strecker T, et al. The Impella Recover microaxial left ventricular assist device reduces mortality for postcardiotomy failure: a three-center experience. J Thorac Cardiovasc Surg 2004;127:812-22
Feldman D, Menachemi DM, Abraham WT, Wexler RK. Manage-ment strategies for stage-D patients with acute heart failure. Clin Cardiol 2008;31:297-301.
Farrar DJ. Ventricular interactions during mechanical circulatory support. Semin Thorac Cardiovasc Surg 1994;6:163-8.
Farrar DJ, Compton PG, Hershon JJ, Fonger JD, Hill JD. Right heart interaction with the mechanically assisted left heart. World J Surg 1985;9:89-102.
Dang NC, Topkara VK, Mercando M, et al. Right heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure. J Heart Lung Transplant 2006;25:1-6.
Kavarana MN, Pessin-Minsley MS, Urtecho J, et al. Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem. Ann Thorac Surg 2002;73:745-50.
Ochiai Y, McCarthy PM, Smedira NG, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation 2002;106:I198-202.
Fitzpatrick JR 3rd, Frederick JR, Hiesinger W, et al. Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J Thorac Cardiovasc Surg 2009;137:971-7
Tsukui H, Teuteberg JJ, Murali S, et al. Biventricular assist device utilization for patients with morbid congestive heart failure: a justifiable strategy. Circulation 2005;112:I65-72.
Kukucka M, Stepanenko A, Potapov E, et al. Right-to-left ventricular end-diastolic diameter ratio and prediction of right ventricular failure with continuous-flow left ventricular assist devices. J Heart Lung Transplant 2011;30:64-9.
Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol 2008;51:2163-72.
Kirklin JK, Naftel DC, Kormos RL, et al. Second INTERMACS annual report: more than 1,000 primary left ventricular assist device implants. J Heart Lung Transplant 2010;29:1-10.
Pagani FD. Continuous-flow rotary left ventricular assist devices with "3rd generation" design. Semin Thorac Cardiovasc Surg. 2008 Fall;20(3):255-63. doi: 10.1053/j.semtcvs.2008.08.002. PMID: 19038736.
Daniel W. Ross, Gerin R. Stevens, Rimda Wanchoo, David T. Majure, Sandeep Jauhar, Harold A. Fernandez, Massini Merzkani, Kenar D. Jhaveri. Left Ventricular Assist Devices and the Kidney. CJASN Feb 2018, 13 (2) 348355; doi: 10.2215/CJN.04670417.
Tosto, C., Adamo, L., Craddock, H. et al. Relationship between device acceptance and patient-reported outcomes in Left Ventricular Assist Device (LVAD) recipients. Sci Rep 9, 10778 (2019). https://doi.org/10.1038/s41598-019-47324-z.
Furukawa K, Motomura T, Nose Y. Right ventricular failure after left ventricular assist device implantation: the need for an implantable right ventricular assist device. Artif Organs 2005;29:369-77.
Fitzpatrick JR 3rd, Frederick JR, Hsu VM, et al. Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support. J Heart Lung Transplant 2008; 27:1286-92.
Kormos RL, Teuteberg JJ, Pagani FD, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg 2010;139:1316-24
Tedford RJ, Hemnes AR, Russell SD, et al. PDE5A inhibitor treatment of persistent pulmonary hypertension after mechanical circulatory support. Circ Heart Fail 2008;1:213-9.
Matamis D, Pampori S, Papathanasiou A, et al. Inhaled NO and sildenafil combination in cardiac surgery patients with out-of-proportion pulmonary hypertension: acute effects on postoperative gas exchange and hemodynamics. Circ Heart Fail 2012;5:47-53.
Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001;345:1435-43.
Martin J, Friesewinkel O, Benk C, Sorg S, Schultz S, Beyersdorf F. Improved durability of the HeartMate XVE left ventricular assist device provides safe mechanical support up to 1 year but is associated with high risk of device failure in the second year. J Heart Lung Transplant 2006;25:384-90.
Starling RC, Naka Y, Boyle AJ, et al. Results of the post-U.S. Food and Drug Administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). J Am Coll Cardiol 2011;57:1890-8.
John R, Kamdar F, Eckman P, et al. Lessons learned from experience with over 100 consecutive HeartMate II left ventricular assist devices. Ann Thorac Surg 2011;92:1593-9.
Cadeiras M, Nagaraj H, Kirklin JK, Holman WL, Pamboukian SV, Misra VK. Use of a vascular plug to percutaneously occlude the outflow conduit of a dysfunctional left ventricular assist device. J Heart Lung Transplant 2011;30:733-4.
Chrysant GS, Horstmanshof DA, Snyder T, et al. Successful percutaneous management of acute left ventricular assist device stoppage. ASAIO J 2010;56:483-5
Holman WL, Skinner JL, Waites KB, Benza RL, McGiffin DC, Kirklin JK. Infection during circulatory support with ventricular assist devices. Ann Thorac Surg 1999;68:711-6.
International Society for Heart and Lung Transplantation. A 2010 working formulation for the standardization of definitions of infections in patients using ventricular assist devices (VADs).
Gordon RJ, Quagliarello B, Lowy FD. Ventricular assist device-related infections. Lancet Infect Dis 2006;6:426-37.
Kimball PM, Flattery M, McDougan F, Kasirajan V. Cellular immunity impaired among patients on left ventricular assist device for 6 months. Ann Thorac Surg 2008;85:1656-61.
Shoham S, Miller LW. Cardiac assist device infections. Curr Infect Dis Rep 2009;11:268-73.
Gristina AG, Dobbins JJ, Giammara B, Lewis JC, DeVries WC. Biomaterial-centered sepsis and the total artificial heart. Microbial adhesion vs tissue integration. JAM 1988;259:870- 4.
Padera RF. Infection in ventricular assist devices: the role of biofilm. Cardiovasc Pathol 2006;15:264-70.
Gordon SM, Schmitt SK, Jacobs M, et al. Nosocomial bloodstream infections in patients with implantable left ventricular assist devices. Ann Thorac Surg 2001;72:725-30.
Hanna HA, Raad II, Hackett B, et al. Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrugresistant bacteremias in critically ill patients. Chest 2003;124:1030-8.
Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1-45.
O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759-69.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250-78.
Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine-alcohol versus povidone- iodine for surgical-site antisepsis. N Engl J Med 2010;362:18-26.
Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons Practice Guideline Series: antibiotic prophylaxis in cardiac surgery, part I: duration. Ann Thorac Surg 2006;81:397-404.
Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000; 101:2916-21.
Eyler RF, Butler SO, Walker PC, et al. Vancomycin use during left ventricular assist device support. Infect Control Hosp Epidemiol 2009;30:484-6.
Engelman R, Shahian D, Shemin R, et al. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, part II: antibiotic choice. Ann Thorac Surg 2007;83:1569-76.
Perl TM. Prevention of Staphylococcus aureus infections among surgical patients: beyond traditional perioperative prophylaxis. Surgery 2003;134:S10-7.
Holman WL, Park SJ, Long JW, et al. Infection in permanent circulatory support: experience from the REMATCH trial. J Heart Lung Transplant 2004;23:1359-65.
Myers TJ, Khan T, Frazier OH. Infectious complications associated with ventricular assist systems. ASAIO J 2000;46:S28-36.
Pasque MK, Hanselman T, Shelton K, et al. Surgical management of Novacor drive-line exit site infections. Ann Thorac Surg 2002;74:1267-8.
Zierer A, Melby SJ, Voeller RK, et al. Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support.Ann Thorac Surg 2007;84:515-20.
Chinn R, Dembitsky W, Eaton L, et al. Multicenter experience: prevention and management of left ventricular assist device infections. ASAIO J 2005;51:461-70.
Garatti A, Giuseppe B, Russo CF, Marco O, Ettore V. Drive-line exitsite infection in a patient with axial-flow pump support: successful management using vacuum-assisted therapy. J Heart Lung Transplant 2007;26:956-9.
Hravnak M, George E, Kormos RL. Management of chronic left ventricular assist device percutaneous lead insertion sites. J Heart Lung Transplant 1993;12:856-63.
Makdisi G, Jan MY, Dungy-Poythress L, Wang IW, Caccamo MA. Successful Delivery in a Patient With Left Ventricular Assist Device and Unplanned Pregnancy. Ann Thorac Surg. 2017 Jul;104(1):e31-e33. doi: 10.1016/j.athoracsur.2017.01.071. PMID: 28633256.
Westcott JM, Yaghoubian Y, Williams MR, Roman AS, Hughes F, Rosner M. Prophylactic percutaneous left ventricular assist device in pregnancy. Obstetric Medicine. 2019;12(3):151-152.
Desai, N, Chaudhry, K, Aji, J. Impella left ventricular assist device in cardiac arrest after spinal anaesthesia for caesarean section. BMJ Case Rep 2015. DOI: 10.1136/bcr-2015-211958.
Seyed Hamed Hosseini Dehkordi et al. Successful pregnancy and delivery with centrifugal flow left ventricular assist device. J Am Coll Cardiol. 2020 Mar, 75.
A.K. Johnson et al. Substance Abuse and Left Ventricular Assist Device Outcomes: Does a History and Type of Use Matter?. The Journal of Heart and Lung Transplantation. Abstract. Volume 34, Issue 4, Supplement , S191-192, april 01, 2015.
Holmes EC. Outpatient management of long-term assist devices. Cardiol Clin 2003;21:93-9.
Wilson SR, Givertz MM, Stewart GC, Mudge GH Jr. Ventricular assist devices: the challenges of outpatient management. J Am Coll Cardiol 2009;54:1647-59.
Morgan JA, Edwards NM. Orthotopic cardiac transplantation: comparison of outcome using biatrial, bicaval, and total techniques. J Card Surg. 2005;20: 102-106.
Heart Transplantation. A Guide for Physicians / Ed. by S.V. Gautier, V.N. Poptsov, A.O. Shevchenko. Moscow - Tver: Triada Publishing House LLC; 2014. (In Russ.)
Chen EP, Bittner HB, Davis RD, Van TP. Hemodynamic and inotropic effects of milrinone after heart transplantation in the setting of recipient pulmonary hypertension. J Heart Lung Transplant 1998;17: 669-78.
Leyh RG, Kofidis T, Struber M, et al. Methylene blue: the drug of choice for catecholamine- refractory vasoplegia after cardiopulmonary bypass? J Thorac Cardiovasc Surg 2003;125:1426- 31.
Argenziano M, Choudhri AF, Oz MC, et al. A prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement. Circulation 1997; 96(9 suppl):II-90.
Morales DL, Garrido MJ, Madigan JD, et al. A double-blind randomized trial: prophylactic vasopressin reduces hypotension after cardio- pulmonary bypass. Ann Thorac Surg 2003;75:926- 30.
Armitage JM, Hardesty RL, Griffith BP. Prostaglandin E1: an effective treatment of right heart failure after orthotopic heart transplantation. J Heart Transplant 1987;6:348-51.
Pascual JM, Fiorelli AI, Bellotti GM, Stolf NA, Jatene AD. Prostacyclin in the management of pulmonary hypertension after heart transplantation. J Heart Transplant 1990;9:644-51.
Theodoraki K, Tsiapras D, Tsourelis L, et al. Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction. Acta Anaesthesiol Scand 2006;50:1213-7.
J. Patel,M. Kittleson,L. Czer,T. Aintablian,R. Sharoff,G. Rodriguez,B. Kearney,N. Perry,A. Hage,F. Esmailian,J.A. Kobashigawa. Severity of Hypertension After Heart Transplant: Does It Impact Outcome?. The Journal of Heart and Lung Transplantation. April 2016. doi:10.1016/j .healun.2016.01.840.
Tanveer A.KhanMD et. al. A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients. The Journal of Thoracic and Cardiovascular Surgery. Volume 138, Issue 6, December 2009, Pages 1417-1424. doi:10.1016/j.jtcvs.2009.04.063.
R. K. Singh et al. The Use of Oral Sildenafil for Management of Right Ventricular Dysfunction After Pediatric Heart Transplantation. American Journal of Transplantation 2014; 14: 453-458.
Kirklin JK, Young JB, McGiffin DC. Heart transplantation. Philadelphia: Churchill Livingstone, 2002.
Bauer J, Dapper F, Demirakca S, et al. Perioperative management of pulmonary hypertension after heart transplantation in childhood. J Heart Lung Transplant 1997;16:1238-47
Addonizio LJ, Gersony WM, Robbins RC, et al. Elevated pulmonary vascular resistance and cardiac transplantation. Circulation 1987;76: V52-5.
Gao SZ, Hunt SA, Wiederhold V, Schroeder JS. Characteristics of serial electrocardiograms in heart transplant recipients. Am Heart J 1991;122:771-4.
Holt ND, McComb JM. Cardiac transplantation and pacemakers: when and what to implant. Card Electrophysiol Rev 2002;6:140-51.
Vaseghi M, Boyle NG, Kedia R, et al. Supraventricular tachycardia after orthotopic cardiac transplantation. J Am Coll Cardiol 2008;51: 2241-9.
Kemkes BM, Schutz A, Engelhardt M, Brandl U, Breuer M. Noninvasive methods of rejection diagnosis after heart transplantation. J HeartLungTransplant 1992;11:S221-31.
Keteyian S, Shepard R, Ehrman J, et al. Cardiovascular responses of heart transplant patients to exercise training. J ApplPhysiol 1991;70: 2627-31.
Kobashigawa JA, Leaf DA, Lee N, et al. A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 1999;340: 272-7.
Kavanagh T, Yacoub MH, Kennedy J, Austin PC. Return to work after heart transplantation: 12-year follow-up. J HeartLungTransplant1999;18:846-51.
Paris W, Woodbury A, Thompson S, et al. Social rehabilitation and return to work after cardiac transplantation—a multicenter survey. Transplantation 1992;53:433-8.
McCartney S.L., Patel C., Del Rio J.M. Long-term outcomes and management of the heart transplant recipient. Best Pract Res Clin Anaesthesiol. 2017;31(2):237-248. doi: 10.1016/j.bpa.2017.06.003.
Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, Mestroni L, Page RL 2nd, Kobashigawa J. Drug therapy in the heart transplant recipient: part I: cardiac rejection and immunosuppressive drugs. Circulation. 2004 Dec 14;110(24):3734-40. doi: 10.1161/01.CIR.0000149745.83186.89.
Tsunoda SM, Aweeka FT. Drug concentration monitoring of immunosuppressive agents: focus on tacrolimus, mycophenolate mofetil and sirolimus. BioDrugs2000;14:355-69.
Hyunyoung Jeong, Bruce Kaplan. Therapeutic Monitoring of Mycophenolate Mofetil. CJASN Jan 2007, 2 (1) 184-191; DOI: 10.2215/CJN.02860806.
Kaczmarek I. et al. Tacrolimus with mycophenolate mofetil or sirolimus compared with calcineurin inhibitor-free immunosuppression (sirolimus/mycophenolate mofetil) after heart transplantation: 5-year results. The Journal of Heart and Lung Transplantation. Volume 32, issue 3, p277-284, march 01, 2013.
Baran DA, Zucker MJ, Arroyo LH, et al. Randomized trial of tacrolimus monotherapy: tacrolimus in combination, tacrolimus alone compared (the TICTAC trial). J Heart Lung Transplant 2007;26:992-7.
Murphy J, Frantz R, Cooper L. Endomyocardial biopsy. In: Murphy J, Lloyd M, editors. Mayo Clinic Cardiology Concise Textbook. Minnesota: Rochester; 2007. p. 1481.
Strecker T et al. Endomyocardial biopsy for monitoring heart transplant patients: 11-years- experience at a german heart center. Int J Clin Exp Pathol. 2013; 6(1): 55-65
Murray H. Kwon, Richard J. Shemin; Tricuspid valve regurgitation after heart transplantation; Ann Cardiothorac Surg. 2017 May; 6(3): 270-274.
Briasoulis A, Inampudi C, Pala M, Asleh R, Alvarez P, Bhama J.Induction immunosuppressive therapy in cardiac transplantation: a systematic review and meta-analysis. Heart Fail Rev. 2018 Sep;23(5):641-649. doi: 10.1007/s10741-018-9691-2.
Daniel Marelli, MD, Fardad Esmailian, MD, Fardad Esmailian ,MD, Samantha Y. Wong, BS, Jon A. Kobashigawa, MD, Murray H. Kwon, MD, Ramin E. Beygui, MD, Hillel Laks, MD, Mark D. Plunkett, MD, Abbas Ardehali, MD, Richard J. Shemin, MD; Tricuspid valve regurgitation after heart transplantation; The Journal of Thoracic and Cardiovascular Surgery; June 2009 Volume 137, Issue 6, Pages 1557-1559.
Koloskova N.N., Poptsov V.N., Shevchenko A.O. The individual tailoring of immunosuppressive therapy after heart transplantation. Vestnik transplantologii i iskusstvennyh organov 2018;(926):127-137. DOI: 10.15825/1995-1191-2018-1-127-137.
Zuckermann A, Schulz U, Deuse T, Ruhpawar A et al. Thymoglobulin induction in heart transplantation: patient selection and implications for maintenance immunosuppression. Transpl. Int. 2015 Mar; 28 (3): 259-269.
Schweiger M. Immunosuppressive Therapy After Cardiac Transplantation. Medical University Graz, Department for Surgery, Division for Transplantation Surgery, Austria. 2014;4-5.
Lars H Lund, Leah B Edwards, Anna Y Kucheryavaya et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report-2015; Focus Theme: Early Graft Failure. The Journal of Heart and Lung Transplantation. 2015; 34 (10): 1245-1253.
Taylor DO, Bristow MR, O’Connell JB, Price GD, Hammond EH, Doty DB, Karwande SV, Gay WA Jr, Jones KW, Lappe D, Renlund DG. Improved long-term survival after heart transplantation predicted by successful early withdrawal from maintenance corticosteroid therapy. J Heart Lung Transplant. 1996; 15: 1039-1046.
Kobashigawa JA, Stevenson LW, Brownfield ED, Gleeson MP, Moriguchi JD, Kawata N, Minkley R, Drinkwater DC, Laks H. Corticosteroid weaning late after heart transplantation: relation to HLA-DR mismatching and long-term metabolic benefits. J Heart Lung Transplant. 1995; 14: 963-967
Grimm M, Rinaldi M, Yonan NA, et al. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients-a large European trial. Am J Transplant 2006; 6:1387.
Groetzner J, Meiser BM, Schirmer J, et al. Tacrolimus or cyclosporine for immunosuppression after cardiac transplantation: which treatment reveals more side effects during long-term follow-up? Transplant Proc 2001; 33:1461.
Lindenfeld J, Miller GG, Shakar SF, et al. Drug therapy in the heart transplant recipient: part II: immunosuppressive drugs. Circulation 2004;110:3858-65.
Meiser BM, Uberfuhr P, Fuchs A, et al. Single-center randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of acute myocardial rejection. J Heart Lung Transplant 1998; 17:782.
Rinaldi M, Pellegrini C, Martinelli L, et al. FK506 effectiveness in reducing acute rejection after heart transplantation: a prospective randomized study. J Heart Lung Transplant 1997; 16:1001.
Reichart B, Meiser B, Vigano M., et al. European Multicenter Tacrolimus (FK506) Heart Pilot Study: one-year results--European Tacrolimus Multicenter Heart Study Group. J Heart Lung Transplant 1998; 17:775.
Taylor DO, Barr ML, Radovancevic B, et al. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 1999; 18:336.
Kobashigawa JA, Miller LW, Russell SD, et al. Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report. Am J Transplant 2006; 6:1377-86.
Eisen HJ, Tuzcu EM, Dorent R, et al. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. N Engl J Med 2003;349:847-58.
Halloran PF, Gourishankar S. Principles and overview of immunosuppression. In: Norman DJ, Laurel NJ, editors. Primer on transplantation. Mt Laurel, NJ: American Society of Transplantation; 2001. p. 87-98.
Baran DA, Zucker MJ, Arroyo LH, et al. Randomized trial of tacrolimus monotherapy: tacrolimus in combination, tacrolimus alone com- pared (the TICTAC trial). J Heart Lung Transplant 2007;26:992-7.
Keogh A, Richardson M, Ruygrok P, et al. Sirolimus in de novo heart transplant recipients reduces acute rejection and prevents coronary artery disease at 2 years: a randomized clinical trial. Circulation 2004;110:2694-700.
Lehmkuhl H, Livi U, Arizon J, et al. Results of a 12-month, multicenter, randomized trial of everolimus with reduced-exposure cyclosporine versus mycophenolate mofetil and standard exposure cyclosporine in de novo cardiac transplantation recipients. J Heart Lung Transplant 2008;27(2S):S65.
Raichlin E, Khalpey Z, Kremers W, et al. Replacement of calcineurin-inhibitors with sirolimus as primary immunosuppression in stable cardiac transplant recipients. Transplantation 2007; 84: 467-74.
Groetzner J, Meiser B, Landwehr P, et al. Mycophenolate mofetil and sirolimus as calcineurin inhibitor-free immunosuppression for late cardiac-transplant recipients with chronic renal failure. Transplantation 2004; 77: 568-74.
Stenton SB, Partovi N, Ensom MH. Sirolimus: the evidence for clinical pharmacokinetic monitoring. Clin Pharmacokinet 2005; 44: 769-86.
Brandhorst G, Tenderich G, Zittermann A, et al. Everolimus exposure in cardiac transplant recipients is influenced by concomitant calcineurin inhibitor. Ther Drug Monit 2008;30:113-6.
Kopp JB, Klotman PE. Cellular and molecular mechanisms of cyclosporin nephrotoxicity. J Am Soc Nephrol 1990; 1: 162-79.
Mahle WT, Vincent RN, Berg AM, Kanter KR. Pravastatin therapy is associated with reduction in coronary allograft vasculopathy in pediatric heart transplantation. J Heart Lung Transplant 2005; 24: 63- 6.
Mehra MR, Uber PA, Vivekananthan K, et al. Comparative beneficial effects of simvastatin and pravastatin on cardiac allograft rejection and survival. J Am Coll Cardiol 2002; 40:1609-14.
Kobashigawa JA, Moriguchi JD, Laks H, et al. Ten-year follow-up of a randomized trial of pravastatin in heart transplant patients. J Heart Lung Transplant 2005; 24:1736-40.
Chin C, Lukito SS, Shek J, Bernstein D, Perry SB. Prevention of pediatric graft coronary artery disease: atorvastatin. Pediatr Transplant 2008;12:442-6.
Muminov I.I., Shevchenko A.O. Clinical efficacy and safety of HMG-CoA reductase inhibitors in heart transplant recipients. In: Transplantation: Results and Prospects. Vol. VIII. 2016. Ed. by S.V. Gautier. Moscow - Tver: Triada Publishing House LLC; 2017. p. 368. (In Russ.)
Shevchenko A.O., Khalilulin T.A., Shevchenko O.P. Mechanisms of non-lipid effects of statins in heart recipients. Russian Journal of Transplantology and Artificial Organs. 2013;2:142-147. (In Russ.)
Patel DN, Pagani FD, Koelling TM, Dyke DB, Baliga RR, Cody RJ, Lake KD, Aaronson KD. Safety and efficacy of atorvastatin in heart transplant recipients. J Heart Lung Transplant. 2002 Feb;21(2):204-10. doi: 10.1016/s1053-2498(01)00369-2. PMID: 11834348.
Hedman M, Neuvonen PJ, Neuvonen M, Holmberg C, Antikainen M. Pharmacokinetics and pharmacodynamics of pravastatin in pediatric and adolescent cardiac transplant recipients on a regimen of triple immunosuppression. Clin Pharmacol Ther 2004;75:101-9.
Mahle WT, Vincent RN, Berg AM, Kanter KR. Pravastatin therapy is associated with reduction in coronary allograft vasculopathy in pediatric heart transplantation. J Heart Lung Transplant 2005;24:63-6.
Chin C, Lukito SS, Shek J, Bernstein D, Perry SB. Prevention of pediatric graft coronary artery disease: atorvastatin. Pediatr Transplant 2008;12:442-6.
Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29(8):914-956. doi: 10.1016/j.healun.2010.05.034. PMID: 20643330.
Lonquist JL, Radovancevic B, Vega JD, et al. Reevaluation of steroid tapering after steroid pulse therapy for heart rejection. J Heart Lung Transplant 1992;11:913-9.
Haverty TP, Sanders M, Sheahan M. OKT3 treatment of cardiac allograft rejection. J Heart Lung Transplant 1993;12:591-8.
Crow S. et al. Efficacy and Safety of Anti-thymocyte Globulin for the Treatment of Acute Cellular Rejection in Orthotopic Heart Transplant. Journal of Cardiac Failure. 2015; 21 (8): S117-S118
Onsager DR, Canver CC, Jahania MS, et al. Efficacy of tacrolimus in the treatment of refractory rejection in heart and lung transplant recipients. J Heart Lung Transplant 1999;18:448- 55.
Chan MC, Kwok BW, Shiba N, et al. Conversion of cyclosporine to tacrolimus for refractory or persistent myocardial rejection. Transplant Proc 2002;34:1850-2.
Hutter JA, Wallwork J, English TA. Management of rejection in heart transplant recipients: does moderate rejection always require treatment? J Heart Transplant. 1990;9(2):87-91
Carrier M. Noninvasive assessment of cardiac transplant rejection. A critical look at the approach to acute rejection. 1991 Dec;34(6):569-72
Keogh AM, Arnold RH, Macdonald PS, et al. A randomized trial of tacrolimus (FK506) versus total lymphoid irradiation for the control of repetitive rejection after cardiac transplantation. J Heart Lung Transplant 2001;20:1331-4.
Cusi V, et al. Incidence of Acute Rejection Compared With Endomyocardial Biopsy Complications for Heart Transplant Patients in the Contemporary Era. Transplantation. 2024. doi: 10.1097/TP.0000000000004882
Takemoto SK, Zeevi A, Feng S, et al. National conference to assess antibody-mediated rejection in solid organ transplantation. Am J Transplant 2004;4:1033-41.
Grauhan O, Knosalla C, Ewert R, et al. Plasmapheresis and cyclophosphamide in the treatment of humoral rejection after heart transplantation. J Heart Lung Transplant 2001;20:316- 21.
Kaczmarek I, Deutsch MA, Sadoni S, et al. Successful management of antibody-mediated cardiac allograft rejection with combined immunoadsorption and anti-CD20 monoclonal antibody treatment: case report and literature review. J Heart Lung Transplant 2007;26:511-5.
Garrett HE Jr, Duvall-Seaman D, Helsley B, Groshart K. Treatment of vascular rejection with rituximab in cardiac transplantation. J Heart Lung Transplant 2005;24:1337-42.
Rose ML, Smith J, Dureau G, Keogh A, Kobashigowa J. Mycophenolate mofetil decreases antibody production after cardiac transplantation. J Heart Lung Transplant 2002;21:282-5.
Itescu S, Burke E, Lietz K, et al. Intravenous pulse administration of cyclophosphamide is an effective and safe treatment for sensitized cardiac allograft recipients. Circulation 2002;105:1214-9.
Leech SH, Lopez-Cepero M, LeFor WM, et al. Management of the sensitized cardiac recipient: the use of plasmapheresis and intravenous immunoglobulin. Clin Transplant 2006;20:476-84.
Kfoury AG, Hammond ME, Snow GL, et al. Early screening for antibody-mediated rejection in heart transplant recipients. J Heart Lung Transplant 2007;26:1264-9.
Michaels PJ, Espejo ML, Kobashigawa J, et al. Humoral rejection in cardiac transplantation: risk factors, hemodynamic consequences and relationship to transplant coronary artery disease. J Heart Lung Transplant 2003;22:58-69.
Miller LW, Wesp A, Jennison SH, et al. Vascular rejection in heart transplant recipients. J Heart Lung Transplant 1993;12:S147-52.
Brunner-La Rocca HP, Schneider J, Kunzli A, Turina M, Kiowski W. Cardiac allograft rejection late after transplantation is a risk factor for graft coronary artery disease. Transplantation 1998;65:538-43.
Klingenberg R, Koch A, Schnabel PA, et al. Allograft rejection of ISHLT grade #/#3A occurring late after heart transplantation—a distinct entity? J Heart Lung Transplant 2003;22:1005-13.
The task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiologie. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). Eur Heart J 2005; 26:1115-40
Krum H, Roecker EB, Mohacsi P, et al. Effects of Initiating Carvedilol in Patients With Severe Chronic Heart Failure: Results From the COPERNICUS Study. JAMA. 2003;289(6):712- 718. doi:10.1001/jama.289.6.712.
Amedeo Chiribiri, MD et al. Long-term Follow-up of Patients Eligible, Deferred, or Ineligible for Heart Transplantation. Clinical heart transplantation; volume 27, issue 4, p380386, april 01, 2008. doi: 10.1016/j.healun.2008.01.011.
Mancini D, Pinney S, Burkhoff D, et al. Use of rapamycin slows progression of cardiac transplantation vasculopathy. Circulation 2003;108:48-53.
Kahan BD, Julian BA, Pescovitz MD, Vanrenterghem Y, Neylan J. Sirolimus reduces the incidence of acute rejection episodes despite lower cyclosporine doses in caucasian recipients of mismatched primary renal allografts: a phase II trial. Rapamune Study Group. Transplantation. 1999 Nov 27;68(10):1526-32. doi: 10.1097/00007890-199911270-00016.
Sheila A Doggrell. Is everolimus useful in preventing allograft rejection and vasculopathy after heart transplant?. J. Expert opinion on investigational drugs. Volume 13, 2004 - Issue 2.
Kobashigawa JA, Tobis JM, Mentzer RM, et al. Mycophenolate mofetil reduces intimal thickness by intravascular ultrasound after heart transplant: reanalysis of the multicenter trial. Am J Transplant 2006;6:993-7.
Kapadia SR, Nissen SE, Ziada KM, et al. Development of transplantation vasculopathy and progression of donor-transmitted atheroscle rosis: comparison by serial intravascular ultrasound imaging. Circulation 1998;98:2672-8.
Johl M et al. Use of the Annual Angiogram After Heart Transplantation: Are They All Necessary? Circulation. 2017;136:A18380
Kobashigawa JA, Tobis JM, Starling RC, et al. Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years. J Am Coll Cardiol 2005;45:1532-7.
Nicolas RT, Kort HW, Balzer DT, et al. Surveillance for transplant coronary artery disease in infant, child and adolescent heart transplant recipients: an intravascular ultrasound study. J Heart Lung Transplant 2006;25:921-7.
Kuhn MA, Jutzy KR, Deming DD, et al. The medium-term findings in coronary arteries by intravascular ultrasound in infants and children after heart transplantation. J Am Coll Cardiol 2000;36:250-4.
Farzaneh-Far A. Electron-beam computed tomography in the assessment of coronary artery disease after heart transplantation. Circulation 2001;103:E60.
Pichler P, Loewe C, Roedler S, et al. Detection of high-grade stenoses with multislice computed tomography in heart transplant patients.J Heart Lung Transplant 2008;27:310-6.
Elkaryoni A et al Diagnostic accuracy of dobutamine stress echocardiography in the detection of cardiac allograft vasculopathy in heart transplant recipients: A systematic review and meta-analysis study. Echocardiography. 2019;36(3):528-536. doi: 10.1111/echo.14268.
Hacker M, Hoyer HX, Uebleis C, et al. Quantitative assessment of cardiac allograft vasculopathy by real-time myocardial contrast echo-cardiography: a comparison with conventional echocardiographic analyses and [Tc99m]-sestamibi SPECT. Eur J Echocardiogr 2008; 9:494-500.
Sakamoto T, Yamada T. Hemodynamic effects of dobutamine in patients following open heart surgery. Circulation. 1977. 1977;55:525-533
Mehra MR. Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy. Am J Transplant 2006;6:1248-56.
Botha P, Peaston R, White K, et al. Smoking after cardiac transplantation. Am J Transplant 2008;8:866-71.
McDonald K, Rector TS, Braulin EA, Kubo SH, Olivari MT. Association of coronary artery disease in cardiac transplant recipients with cytomegalovirus infection. Am J Cardiol 1989;64:359-62.
Simmonds J, Fenton M, Dewar C, et al. Endothelial dysfunction and cytomegalovirus replication in pediatric heart transplantation. Circulation 2008;117:2657-61.
Hussain T, Burch M, Fenton MJ, et al. Positive pretransplantation cytomegalovirus serology is a risk factor for cardiac allograft vasculopathy in children. Circulation 2007;115:1798-1805.
Kato T, Chan MC, Gao SZ, et al. Glucose intolerance, as reflected by hemoglobin A1c level, is associated with the incidence and severity of transplant coronary artery disease. J Am Coll Cardiol 2004;43:1034-41.954
Schroeder JS, Gao SZ, Alderman EL, et al. A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients. N Engl J Med 1993;328:164- 70.
Erinc K, Yamani MH, Starling RC, et al. The effect of combined Angiotensin-converting enzyme inhibition and calcium antagonism on allograft coronary vasculopathy validated by intravascular ultra-sound. J Heart Lung Transplant 2005;24:1033-8.
Halle AA, III, DiSciascio G, Massin EK, et al. Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients. J Am Coll Cardiol 1995;26:120-8.
Aqel RA, Wells BJ, Hage FG, et al. Re-stenosis after drug-eluting stents in cardiac allograft vasculopathy. J Heart Lung Transplant 2008;27:610-5.
Radovancevic B, McGiffin DC, Kobashigawa JA, et al. Retransplantation in 7,290 primary transplant patients: a 10-year multi-institutional study. J Heart Lung Transplant 2003;22:862-8.
Farzaneh-Far A. Electron-beam computed tomography in the assessment of coronary artery disease after heart transplantation. Circulation 2001; 103: E60.
Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure / P. Atluri, W. Hiesinger, R.C. Gorman et al. // J. Cardiothoracic Surg. - 2008. - 7. - P. 3-26. doi: 10.1186/1749-8090-3-26.
Retransplantation in 7290 primary transplant patients: a 10-year multi-institutional study / B. Radovancevic, D.C. McGiffin, J.A. Kobashigawa, et al. // J. Heart Lung Transplant. - 2003. - 22. - P.862-8.
Ross retransplant and medical therapy for cardiac allograft vasculopathy: International Society for Heart and Lung Transplantation registry analysis /L.A. Goldraich, J. Stehlik, A.Y. Kucheryavaya, L.B. Edwardsand // American Journal of Transplantation. - 2016. - 16. - P. 301309.
Heart retransplantation / M.R. Johnson, K.D. Aaronson, C.E. Canter et al. //Am J Transplant. - 2007. - 7. - P.2075-81.
Andryushchenko A.V., Arutyunov G.P., Atkov O.Yu., Balakhonova T.V., Baranova E.I., Bolshakova O.O., Vasichkina E.S., Vasyuk Yu.A., Galyavich A.S., Gordeev M.L., Gautier S.V., Gudkova A.Ya., Gurshchenkov A.V., Demin A.A., Demchenko E.A., Dzemeshkevich S.L., Zvartau N.E., Zemtsovskiy E.V., Zolotukhin I.A., Karpov R.S., Shevchenko A.O., et al. CARDIOLOGY. NATIONAL GUIDELINES. Short edition. Moscow; 2018. (2nd revised and expanded edition). (In Russ.)
Shevchenko A.O., Nikitina E.A., Tyunyaeva I.Yu. Arterial hypertension in heart transplant recipients. Russian Journal of Transplantology and Artificial Organs. 2017;19(2):114-125. (In Russ.)
Ambrosi P, Kreitmann B, Habib G. Does heart rate pre- diet allograft vasculopathy in heart transplant recipients? Int. J. Cardiol. 2010; 145: 256-257.
Lehoux S, Tedgui A. Signal transduction of mechanical stresses in the vascular wall. Hypertension. 1998; 32: 338-345.
Vasyuk Yu.A., Ivanova S.V., Shkolnik E.L., Kotovskaya Yu.V., Milyagin V.A., Oleynikov V.E., Orlova Ya.A., et al. Russian experts consensus on arterial stiffness assessment in clinical practice. Cardiovascular Therapy and Prevention. 2016;15(2):4-19. (In Russ.)
Shevchenko A.O., Tunyaeva I.U., Nasyrova A.A. Common carotid artery wall rigidity index is a marker of cardiac allograft rejection. The Journal of Heart and Lung Transplantation. 2015;34(4 Suppl):S298.
Nichols WW, Denardo SJ, Wilkinson IB, McEniery CM, Cockcroft J, O’Rourke MF. Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform. J. Clin. Hypertens. (Greenwich). 2008; 10 (4): 295-303.
Nasyrova A.A., Shevchenko A.O. Functional parameters of main arteries and the risk of cardiac allograft rejection. In: Transplantation: Results and Prospects. Vol. VII. 2015. Ed. by S.V. Gautier. Moscow - Tver: Triada; 2016. p. 331-350. (In Russ.)
Boytsov S.A. The study of the pathogenesis of hypertension continues. Terapevticheskii Arkhiv. 2006;78(9):1-12. (In Russ.)
Braith RW, Mills RM, Wilcox CS et al. Breakdown of blood pressure and body fluid homeostasis in heart trans- plant recipients. J. Am. Coll. Cardiol. 1996; 27: 375-383.
Braith RW, Mills RM, Wilcox CS et al. Fluid homeostasis after heart transplantation: the role of cardiac denervation. J. Heart Lung Transplant. 1996; 15: 872-880.
Braith RW, Mills RM, Wilcox CS et al. High dose angiotensin-converting enzyme inhibition prevents fluid volume expansion in heart transplant recipients. Journal of the American College of Cardiology. 2000; 36 (2): 487-492.
Zimmer RJ, Lee MS. Transplant Coronary Artery Disease. JACC: Cardiovascular Interventions. 2010; 3 (4): 367-377.
Borgese L, Potena L, Resciniti E et al. Influence of angiotensin-type1-receptor antibodies in chronic vascular injury on heart transplant patients. The Journal of Heart and Lung Transplantation. 2015; 34 (4): 99-S100.
Canzanello VJ, Textar SC, Taler SJ et al: Late hypertension after liver transplantation: A comparison of cyclosporine and tacrolimus (FK 506). Liver Transpl Surg, 1998; 4: 328-34.
Mozheyko N.P., Ilyinsky I.M., Mironkov B.L., Poptsov V.N., Koloskova N.N., Shevchenko A.O., Shevchenko O.P. Acute cellular rejection in the late post-transplant period. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):77. (In Russ.)
Shevchenko A.O., Tyunyaeva I.Yu., Nasyrova A.A., Mironkov B.L., Ilyinsky I.M., Mozheyko N.P., Muminov I.I., Shevchenko O.P. Cardiac allograft rejection and non-invasive parameters of the functional state of the common carotid artery wall. Russian Journal of Transplantology and Artificial Organs. 2015;17(1):5-11. (In Russ.)
Sakhovskiy S.A., Izotov D.A., Koloskova N.N., Muminov I.I., Ahmadzai R.L., Faradzhov R.A., Spirina E.A., Poptsov V.N., Mironkov B.L., Shevchenko A.O. Angiographic evaluation of coronary atherosclerosis in the cardiac allograft. Russian Journal of Transplantology and Artificial Organs. 2018;20(4):22-29. (In Russ.)
Poptsov V.N., Spirina E.A., Ukhrenkov S.G., Mebonia N.Z., Pchelnikov V.V., Masyutin S.A., Voronkov V.Yu., Aliev E.Z. Anesthesia and intensive care in heart transplantation in elderly recipients. Russian Journal of Transplantology and Artificial Organs. 2016;18(S):29. (In Russ.)
Shevchenko A.O., Gautier S.V., Poptsov V.N., Saitgareev R.Sh., Zakharevich V.M., Shumakov D.V. Thirty-year trends in survival rates of end-stage heart failure patients after heart transplantation according to the Academician V.I. SHUMAKOV NMRCTAO registry data. Eurasian Cardiological Journal. 2016;3:171-172. (In Russ.)
Gautier S.V., Poptsov V.N., Saitgareev R.Sh., Shumakov D.V., Zakharevich V.M., Spirina E.A. Scientific, technological and organizational solutions to improve the efficiency and timeliness of heart transplantation. Russian Journal of Transplantology and Artificial Organs. 2014;16(3):14-22. (In Russ.)
Gabibov N.I., Savostyanova O.A., Gorskaya E.M., Batyrshina L.R., Romashkina L.Yu., Poptsov V.N., Akimkin V.G. Epidemiological and microbiological characteristics of the postoperative period in elderly cardiac surgery patients. Epidemiology and Vaccinal Prevention. 2015;14(5):51-55. (In Russ.)
Romanova N.I., Gorskaya E.M., Esenova N.M., Zakharevich V.M., Saitgareev R.Sh., Gabrielyan N.I. Environmental microflora as a threat to the development of infectious pathology in patients after orthotopic heart transplantation. Meditsinskiy alfavit. 2016;1(6):47-55. (In Russ.)
Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation 2012;126:975-90.
Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019;53:1801913. https://doi.org/10.1183/13993003.01913-2018.
Bursi F, McNallan SM, Redfield MM, et al. Pulmonary pressures and death in heart failure: a community study. J Am Coll Cardiol 2012;59:222-31. https://doi.org/10.1016/j.jacc.2011.06.076. Mironkov B.L. Endovascular interventions in heart transplant recipients. Russian Journal of Transplantology and Artificial Organs. 2015;17(2):77-79. (In Russ.)
Mironkov B.L., Chestukhin V.V., Tyunyaeva I.Yu., Ryadovoy I.G., Ostroumov E.N., Shevchenko A.O., Mironkov A.B., Kormer A.Ya. Clinical efficacy of myocardial revascularization in cardiac allograft vasculopathy. Russian Journal of Transplantology and Artificial Organs. 2014;16(4):5-10. (In Russ.)
Halle AA, III, DiSciascio G, Massin EK, et al. Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients. J Am Coll Cardiol 1995; 26:120-8.
Gautier S.V., Poptsov V.N., Saitgareev R.Sh., Shumakov D.V., Zakharevich V.M., Khalilulin T.A., Golts A.M., Akopov G.A., Zakiryanov A.R., Mironkov B.L., Shevchenko A.O., Mozheyko N.P. Heart retransplantation strategy: outcomes and challenges. Russian Journal of Transplantology and Artificial Organs. 2016;18(S):32. (In Russ.)
Gautier S.V., Poptsov V.N., Saitgareev R.Sh., Zakharevich V.M., Shevchenko A.O., Akopov G.A., Khalilulin T.A., Golts A.M., Zakiryanov A.R., Koloskova N.N. Heart retransplantation as the only effective treatment method for end-stage cardiac allograft dysfunction. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):63-64. (In Russ.)
Paris W, Woodbury A, Thompson S, et al. Social rehabilitation and return to work after cardiac transplantation-a multicenter survey. Transplantation 1992;53: 433-8.
Saitgareev R.Sh., Zakharevich V.M., Golts A.M., Khalilulin T.A., Borisov D.V. Heart retransplantation. Russian Journal of Transplantology and Artificial Organs. 2016;18(2):142-151. (In Russ.)
Keteyian S, Shepard R, Ehrman J, et al. Cardiovascular responses of heart transplant patients to exercise training. J Appl Physiol 1991;70: 2627-31.
Kobashigawa JA, Leaf DA, Lee N, et al. A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 1999; 340 : 272-7.
Braith RW, Schofield RS, Hill JA, Casey DP, Pierce GL. Exercise training attenuates progressive decline in brachial artery reactivity in heart transplant recipients. J Heart Lung Transplant 2008;27:52-9.
Pierce GL, Schofield RS, Casey DP, et al. Effects of exercise training on forearm and calf vasodilation and proinflammatory markers in recent heart transplant recipients: a pilot study. Eur J Cardiovasc Prev Rehabil 2008;15:10-8.
Haykowsky M, Taylor D, Kim D, Tymchak W. Exercise training improves aerobic capacity and skeletal muscle function in heart transplant recipients. Am J Transplant 2009;9:734-9.
Braith RW, Magyari PM, Fulton MN, et al. Resistance exercise training and alendronate reverse glucocorticoid-induced osteoporosis in heart transplant recipients. J Heart Lung Transplant 2003;22:1082- 90.
Braith RW, Welsch MA, Mills RM Jr, Keller JW, Pollock ML. Resistance exercise prevents glucocorticoid-induced myopathy in heart transplant recipients. Med Sci Sports Exerc 1998;30:483-9.
White-Williams C, Jalowiec A, Grady K. Who returns to work after heart transplantation? J Heart Lung Transplant 2005; 24:2255-61.
Volkova O.V. Social rehabilitation as a direction of social work. Psikhologo-pedagogicheskiy zhurnal Gaudeamus. 2006;2(10):171-177. (In Russ.)
Fusar-Poli P, Picchioni M, Martinelli V, et al. Anti-depressive therapies after heart transplantation. J Heart Lung Transplant 2006; 25: 785-93.
Dew MA, DiMartini AF, De Vito DA, et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ trans- plantation. Transplantation 2007;83:858-73.
Havik OE, Sivertsen B, Relbo A, et al. Depressive symptoms and all-cause mortality after heart transplantation. Transplantation 2007; 84:97-103.
Lawrence K, Stilley CS, Olshansky E, Bender A, Webber SA. Further exploration: maturity and adherence in adolescent and young adult heart transplant recipients. Prog Transplant 2008;18:50-4.
De Bleser L, Matteson M, Dobbels F, Russell C, De GS. Interventions to improve medication-adherence after transplantation: a systematic review. Transpl Int 2009;22:780-97.
Wray J, Waters S, Radley-Smith R, Sensky T. Adherence in adolescents and young adults following heart or heart-lung transplantation. Pediatr Transplant 2006;10:694-700.
Coscia LA, Constantinescu S, Moritz MJ, et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl 2007; 29-42.
Sibanda N, Briggs JD, Davison JM, Johnson RJ, Rudge CJ. Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation 2007; 83: 1301-7.
Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-89.
Estes CM, Westhoff C. Contraception for the transplant patient. Se- min Perinatol 2007;31:372-7.
Sucato GS, Murray PJ. Gynecologic health care for the adolescent solid organ transplant recipient. Pediatr Transplant 2005; 9: 346-56.
McKay DB, Josephson MA, Armenti VT, et al. Reproduction and transplantation: report on the AST Consensus Conference on Reproductive Issues and Transplantation. Am J Transplant 2005; 5: 1592-9.
Schofield RS, Edwards DG, Schuler BT, et al. Vascular effects of sildenafil in hypertensive cardiac transplant recipients. Am J Hypertens 2003;16: 874-7.
Halinen MO, Jaussi A. Fatal road accidents caused by sudden death of the driver in Finland and Vaud, Switzerland. Eur Heart J 1994; 15: 888-94.
Ostrom M, Eriksson A. Natural death while driving. J Forensic Sci. 1987;32: 988- 98.
McFarland RA, Moore RC. Accidents and accident prevention. In Annual Review of Medicine Vol. 13. ed. Rystand DA, Creger WP. Palo Alto CA. Annual Reviews, Inc. 1962.
Petch MC. Task Force Report. Driving and heart disease. Eur Heart J. 1998;19:1165-1177.
Petch M, Irvine J. Cardiovascular disorders and vocational driving. The Practitioner. 1995;239:37-39.
Miles W. Driving issues related to arrhythmic syncope. Cardiol. Clinics. 1997;15: 327-39.
Australasian Faculty of Occupational Medicine. Medical examinations of commercial vehicle drivers. National Road Transport Commission and the Federal Office of Road Safety. April 1997.
Cooper R, Cutler J, Desvigne-Nickens P, et al. Trend and disparities in coronary heart disease, stroke and other cardiovascular diseases in the United States: Findings of the National Conference on Cardiovascular Disease Prevention. Circulation. 2000;102:3137-47.
Cupples LA, Gaglon DR, Kannel WB. Long and short term risks of coronary death. Circulation. 1992;85(Supplement 1):11-18.
Tsunoda SM, Aweeka FT. Drug concentration monitoring of immunosuppressive agents: focus on tacrolimus, mycophenolate mofetil and sirolimus. BioDrugs 2000;14:355-69.
Knight SR, Morris PJ. Does the evidence support the use of mycophenolate mofetil therapeutic drug monitoring in clinical practice? A systematic review. Transplantation 2008;85:1675-85.
Michaels PJ, Espejo ML, Kobashigawa J, et al. Humoral rejection in cardiac transplantation: risk factors, hemodynamic consequences and relationship to transplant coronary artery disease. J Heart Lung Transplant 2003;22: 58-69.
Shevchenko A.O. Lipid-lowering therapy in heart recipients: statins. Russian Journal of Transplantology and Artificial Organs. 2016;18(2):171-176. (In Russ.)
Randhawa P, Brennan DC. BK virus infection in transplant recipients: an overview and update. Am J Transplant 2006; 6: 2000-5.
Kubak BM, Gregson AL, Pegues DA, et al. Use of hearts transplanted from donors with severe sepsis and infectious deaths. J Heart Lung Transplant 2009; 28:260-5.
Crespo-Leiro MG, onso-Pulpon L, Vazquez de Prada JA, et al. Malignancy after heart transplantation: incidence, prognosis and risk factors. Am J Transplant 2008;8 : 1031-9.
O'Neill JO, Edwards LB, Taylor DO. Mycophenolate mofetil and risk of developing malignancy after orthotopic heart transplantation: analysis of the transplant registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006; 25: 1186-91.
Valantine H. Is there a role for proliferation signal/mTOR inhibitors in the prevention and treatment of de novo malignancies after heart transplantation? Lessons learned from renal transplantation and oncology. J Heart Lung Transplant 2007; 26: 557-64.
Webber SA, Naftel DC, Fricker FJ, et al. Lymphoproliferative disorders after paediatric heart transplantation: a multi-institutional study. Lancet 2006; 367: 233-9.
Bloom RD, Doyle AM. Kidney disease after heart and lung transplantation. Am J Transplant 2006;6:671-9.
Wilkinson AH, Cohen DJ. Renal failure in the recipients of nonrenal solid organ transplants. J Am Soc Nephrol 1999;10:1136-44.
Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol 2007; 27: 498-507.
Poz Ya.L., Strokov A.G., Poptsov V.N., Kopylova Yu.V., Kryshin K.N. Kidney injury and renal replacement therapy in the heart transplant recipient. Russian Journal of Transplantology and Artificial Organs. 2017;19(1):52-56. (In Russ.)
Raichin E, Kushwaha SS, Daly RC et al. Combined heart and kidney transplantation provides excellent survival and decreased risk of cellular rejection and coronary allograft vasculopathy. Transplant Proc. 2011; 43: 1871- 1776.
Trachiotis GD, Vega JD, Jonhnston TS et al. Ten-year follow-up in patients with combined heart and kidney transplantation. J Thorac Cardiovasc Surg. 2003; 123: 2065-2071.
Gill J, Shah T, Hristea I et al. Outcomes of simultaneous heart-kidney transplant in the US: a retrospective analysis using OPTN/UNOS data. Am J Transplant. 2009; 9: 844-852.
Shevchenko A.O., Nikitina E.A., Mozheyko N.P., Tyunyaeva I.Yu., Koloskova N.N. Prevalence and predictors of arterial hypertension in heart transplant recipients. Russian Journal of Transplantology and Artificial Organs. 2017;19(3):33-39. (In Russ.)
Shevchenko A.O., Tyunyaeva I.Yu., Nikitina E.A., Orlov V.I. Prescription of angiotensin-converting enzyme inhibitors improves prognosis in heart transplant recipients with cardiac allograft myocardial hypertrophy. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):85. (In Russ.)
Kalinina A.M., Boytsov S.A., Kushunina D.V., Gorny B.E., Drozdova L.Yu., Egorov V.A. Arterial hypertension in real-world clinical practice: what the results of medical examinations show. Arterialnaya Gipertenziya. 2017;23(1):6-16. (In Russ.)
van de Beek D, Kremers W, Daly RC, et al. Effect of neurologic complications on outcome after heart transplant. Arch Neurol 2008; 65:226-31.
Zierer A, Melby SJ, Voeller RK, et al. Significance of neurologic complications in the modern era of cardiac transplantation. Ann Thorac Surg 2007;83:1684-90.
Mayer TO, Biller J, O’Donnell J, Meschia JF, Sokol DK. Contrasting the neurologic complications of cardiac transplantation in adults and children. J Child Neurol 2002;17:195-9.
Marchetti P. New-onset diabetes after transplantation. J Heart Lung Transplant 2004;23(5 suppl):S194-201
Hathout EH, Chinnock RE, Johnston JK, et al. Pediatric posttransplant diabetes: data from a large cohort of pediatric heart-transplant recipients. Am J Transplant 2003;3: 994-8.
Pham PT, Pham PC, Lipshutz GS, Wilkinson AH. New onset diabetes mellitus after solid organ transplantation. Endocrinol Metab Clin North Am 2007;36: 873-90.
Leidig-Bruckner G, Hosch S, Dodidou P, et al. Frequency and predictors of osteoporotic fractures after cardiac or liver transplantation: a follow-up study. Lancet 2001; 357:342-7.
Kapetanakis EI, Antonopoulos AS, Antoniou TA, et al. Effect of long-term calcitonin administration on steroid-induced osteoporosis after cardiac transplantation. J Heart Lung Transplant 2005; 24: 526- 32.
Pisani B, Mullen GM. Prevention of osteoporosis in cardiac transplant recipients. Curr Opin Cardiol 2002;17:160-4.
Guo CY, Johnson A, Locke TJ, Eastell R. Mechanisms of bone loss after cardiac transplantation. Bone 1998; 22:267-71.
Shane E, Addesso V, Namerow PB, et al. Alendronate versus calcitriol for the prevention of bone loss after cardiac transplantation. N Engl J Med 2004; 350:767-76.
Braith RW, Magyari PM, Fulton MN, et al. Comparison of calcitonin versus calcitonin plus resistance exercise as prophylaxis for osteoporosis in heart transplant recipients. Transplantation 2006;81:1191-5.
Van Cleemput J, Daenen W, Geusens P,et al. Prevention of boneloss in cardiac transplant recipients. A comparison of biphosphonates and vitamin D. Transplantation 1996;61:1495-9.
Cohen A, Addesso V, McMahon DJ, et al. Discontinuing antiresorptive therapy one year after cardiac transplantation: effect on bone density and bone turnover. Transplantation 2006; 81:686-91.
Gautier S.V., Khomyakov S.M. Organ donation and transplantation in the Russian Federation in 2017. 10th report of the Russian Transplant Society register. Russian Journal of Transplantology and Artificial Organs. 2018;20(2):6-28. (In Russ.)
Gautier S.V. Innovations in transplantology: development of the heart transplantation program in the Russian Federation. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2017;21(3S):61-68. (In Russ.)
Gautier S.V., Khomyakov S.M. Organ donation and transplantation in the Russian Federation in 2016. 9th report of the Russian Transplant Society register. Russian Journal of Transplantology and Artificial Organs. 2017;19(2):6-26. (In Russ.)
Gautier S.V., Khomyakov S.M. Improvement of the regulatory framework in the field of human organ and tissue donation and transplantation at the level of a constituent entity of the Russian Federation. Russian Journal of Transplantology and Artificial Organs. 2017;19(S):8-9. (In Russ.)
Gautier S.V., Shevchenko A.O., Saitgareev R.Sh., Zakharevich V.M., Poptsov V.N., Zubkova E.A., Dontsov V.V. Comparative analysis of short-term and long-term survival prognosis of heart transplant recipients operated on in different years. Russian Journal of Transplantology and Artificial Organs. 2016;18(S):26-27. (In Russ.)
Lund LH et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Heart Transplantation Report - 2016. The Journal of Heart and Lung Transplantation. 2016; 35 (10): 1158- 1169.
Gautier SV, Shevchenko AO, Poptsov VN. Patsient s transplantirovannym serdtsem (ISBN: 978-5-94789-648-0). Moscow-Tver: Triada; 2014. 144 p. (In Russ.)
Cousino MK, Miller VA, Smith C, Uzark K, Lowery R, Rottach N, Blume ED, Schumacher KR. Medical and end-of-life decision making in adolescents' pre-heart transplant: A descriptive pilot study. Palliat Med. 2020 Mar;34(3):272-280. doi: 10.1177/0269216319874689
Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010; 29:914.
Pollesello P, Parissis J, Kivikko M, Harjola VP. Levosimendan meta-analyses: is there a pattern in the effect on mortality? Int J Cardiol 2016;209:77-83
Landoni G, Mizzi A, Biondi-Zoccai G, et al. Reducing mortality in cardiac surgery with levosimendan: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2010;24:51-57
Harrison RW, Hasselblad V, Mehta RH, Levin R, Harrington RA, Alexander JH. Effect of levosimendan on survival and adverse events after cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2013;27:1224-1232
Mehta RH, Leimberger JD, van Diepen S, et al. Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery. N Engl J Med 2017;376:2032-2042
Landoni G, Lomivorotov VV, Alvaro G, et al. Levosimendan for hemodynamic support after cardiac surgery. N Engl J Med 2017;376:2021-2031
Papp Z, Edes I, Fruhwald S, et al. Levosimendan: molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan. Int J Cardiol2012;159:82-87
Zipfel S, Reiter B, Barten M, Rybczinski M, Schrage B, Westermann D, et al. Levosimendan effects benefit weaning from veno-arterial extracorporeal life support. J Heart Lung Transplant. 2018;37:S383.
Schumann J, Henrich EC, Strobl H, Prondzinsky R, Weiche S, Thiele H, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2018;1:CD009669.
Scheeren T.W.L. et al. Current use of inotropes in circulatory shock. Ann. Intensive Care. 2021; 11:21 https://doi.org/10.1186/s13613-021-00806-8
Bart Hiemstra, Geert Koster, J0rn Wetterslev, Christian Gluud, Janus C. Jakobsen, Thomas W. L. Scheeren, Frederik Keus, Iwan C. C. van der Horst. Dopamine in critically ill patients with cardiac dysfunction: A systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiologica Scandinavica. 2019; 63(4): 424-437.
De Backer D et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. N Engl J Med 2010; 362:779-789
Simsch O. et al. The intensive care management of patients following heart transplantation at the Deutsches Herzzentrum Berlin. Applied Cardiopulmonary Pathophysiology. 2011; 15: 230-240
Freeman R. et al. Cardiac Transplant Postoperative Management and Care. Critical Care Nursing Quarterly. 2016; 39(3): 214-226. doi: 10.1097/CNQ.0000000000000116
Higgins R, Kirklin JK, Brown RN, et al. To induce or not to induce: do patients at greatest risk for fatal rejection benefit from cytolytic induction therapy? J Heart Lung Transplant 2005; 24:392.
Rosenberg PB, Vriesendorp AE, Drazner MH, et al. Induction therapy with basiliximab allows delayed initiation of cyclosporine and preserves renal function after cardiac transplantation. J Heart Lung Transplant. 2005;24(9):1327.
Yamani MH, Taylor DO, Czerr J, et al. Thymoglobulin induction and steroid avoidance in cardiac transplantation: results of a prospective, randomized, controlled study. Clin Transplant 2008; 22:76.
Cantarovich M, Giannetti N, Barkun J, Cecere R. Antithymocyte globulin induction allows a prolonged delay in the initiation of cyclosporine in heart transplant patients with postoperative renal dysfunction. Transplantation 2004; 78:779.
Anselm A., Cantarovich M., Davies R., et al. Prolonged basiliximab use as an alternative to calcineurin inhibition to allow renal recovery late after heart transplantation. J Heart Lung Transplant. 2008; 27: 1043-1045
Khush KK, Cherikh WS, Chambers DC, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. J Heart Lung Transplant 2019; 38:1056.
Hardinger KL, Rhee S, Buchanan P, et al. A prospective, randomized, double-blinded comparison of thymoglobulin versus Atgam for induction immunosuppressive therapy: 10-year results. Transplantation 2008; 86:947.
Brennan DC, Flavin K, Lowell JA, et al. A randomized, double-blinded comparison of Thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients. Transplantation 1999; 67:1011.
El-Hamamsy I, Stevens LM, Carrier M, et al. Incidence and prognosis of cancer following heart transplantation using RATG induction therapy. Transpl Int 2005; 18:1280.
Carrier M, Leblanc MH, Perrault LP, et al. Basiliximab and rabbit anti-thymocyte globulin for prophylaxis of acute rejection after heart transplantation: a non-inferiority trial. J Heart Lung Transplant 2007; 26:258.
Ansari D. et al. Comparison of Basiliximab and Anti-Thymocyte Globulin as Induction Therapy in Pediatric Heart Transplantation: A Survival Analysis. J Am Heart Assoc. 2016;5:e002790. https://doi.org/10.1161/JAHA.115.002790
Ansari D., Lund L.H., Stehlik J., et al. Induction with anti-thymocyte globulin in heart transplantation is associated with better long-term survival compared with basiliximab. Journal of Heart and Lung Transplantation. 2015; 34 (10): 1283-1291.
Amin A.A., Araj F.G., Ariyamuthu, et al. Impact of induction immunosuppression on patient survival in heart transplant recipients treated with tacrolimus and mycophenolic acid in the current allocation era. Clinical Transplantation. 2019; 33 (8): e13651
Tzani A., Van den Eynde J., Doulamis I.P., et al. Impact of induction therapy on outcomes after heart transplantation. Clinical Transplantation. 2021; 35 (10): e14440
Mehra M.R., Zucker M.J., Wagoner L., et al. A multicenter, prospective, randomized, double-blind trial of basiliximab in heart transplantation. J Heart Lung Transplant. 2005; 24: 1297-1304
Chou N.K., Wang S.S., Chen Y.S., et al. Induction Immunosuppression With Basiliximab in Heart Transplantation. Transplantation Proceedings. 2008; 40 (8): 2623-2625.
Mattei M.F. et al. Lower risk of infectious deaths in cardiac transplant patients receiving basiliximab versus anti-thymocyte globulin as induction therapy. J Heart Lung Transplant. 2007;26(7):693-9. doi: 10.1016/j.healun.2007.05.002.
Kittipibul V., Tantrachoti P., Ongcharit P., et al. Low-dose basiliximab induction therapy in heart transplantation. Clinical Transplantation 2017; 31 (12): e13132
Briasoulis A., Inampudi C., Pala, M., et al. Induction immunosuppressive therapy in cardiac transplantation: a systematic review and meta-analysis. Heart Failure Reviews. 2018; 23 (5): 641-649.
Kobashigawa JA, Patel J, Furukawa H, et al. Five-year results of a randomized, singlecenter study of tacrolimus vs microemulsion cyclosporine in heart transplant patients. J Heart Lung Transplant 2006; 25:434.
Kobashigawa J, Miller L, Renlund D, et al. A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients. Mycophenolate Mofetil Investigators. Transplantation 1998; 66:507.
Kobashigawa JA, Renlund DG, Gerosa G, et al. Similar efficacy and safety of enteric-coated mycophenolate sodium (EC-MPS, myfortic) compared with mycophenolate mofetil (MMF) in de novo heart transplant recipients: results of a 12-month, single-blind, randomized, parallel-group, multicenter study. J Heart Lung Transplant 2006; 25:935
Lehmkuhl H, Hummel M, Kobashigawa J, et al. Enteric-coated mycophenolate-sodium in heart transplantation: efficacy, safety, and pharmacokinetic compared with mycophenolate mofetil. Transplant Proc 2008; 40:953.
Cohen DJ. Action, efficacy and toxicities: corticosteroids. In: Norman DJ, Turka LA, eds. Primer on Transplantation. Mt Laurel, NJ: American Society of Transplantation; 2001: 146-151.
Auphan N, DiDonato JA, Rosette C, Helmberg A, Karin M. Immunosuppression by glucocorticoids: inhibition of NF-kappa B activity through induction of I kappa B synthesis. Science. 1995; 270: 286-290.
Hosenpud JD, Norman DJ, Pantely GA. Low-dose oral prednisone in the treatment of acute cardiac allograft rejection not associated with hemodynamic compromise. J Heart Transplant. 1990; 9: 292-296
Kuppahally S, Al-Khaldi A, Weisshaar D, et al. Wound healing complications with de novo sirolimus versus mycophenolate mofetil-based regimen in cardiac transplant recipients. Am J Transplant 2006; 6:986.
Gonzalez-Vdchez F, de Prada JA, Exposito V, et al. Avoidance of calcineurin inhibitors with use of proliferation signal inhibitors in de novo heart transplantation with renal failure. J Heart Lung Transplant 2008; 27:1135.
Eisen HJ, Kobashigawa J, Starling RC, et al. Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial. Am J Transplant 2013; 13:1203.
Andreassen AK, Andersson B, Gustafsson F, et al. Everolimus initiation and early calcineurin inhibitor withdrawal in heart transplant recipients: a randomized trial. Am J Transplant 2014; 14:1828.
Gautier S.V., Khomyakov S.M. Organ donation and transplantation in the Russian Federation in 2020. 13th report of the Russian Transplant Society register. Russian Journal of Transplantology and Artificial Organs. 2021;23(3):8-34. https://doi.org/10.15825/1995-1191-2021-3-8-34
Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artemyeva E.G., Badin Yu.V., Bakulina E.V., Vinogradova N.G., Galyavich A.S., Ionova T.S., Kamalov G.M., Kechedzhieva S.G., Koziolova N.A., Malenkova V.Yu., Malchikova S.V., Mareev Yu.V., Smirnova E.A., Tarlovskaya E.I., Shcherbinina E.V., Yakushin S.S. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. https://doi.org/10.18087/cardio.2021.4.n1628.
Everolimus conversion for renal function preservation in heart transplantation: a personalized approach to immunosuppressive therapy. N. N. Koloskova, E. A. Nikitina, V. M. Zakharevich, I. I. Muminov, V. S. Kwan, V. N. Poptsov, R. L. Ahmadzai, D. A. Izotov, A. O. Shevchenko https://doi.org/10.15825/1995-1191-2018-3-70-74
Strong, C., Raposo, L., Castro, M., Madeira, S., Tralhão, A., Ventosa, A., Rebocho, M. J., Almeida, M., Aguiar, C., Neves, J. P., and Mendes, M. (2020) Haemodynamic effects and potential clinical implications of inhaled nitric oxide during right heart catheterization in heart transplant candidates. ESC Heart Failure, 7: 673–681. https://doi.org/10.1002/ehf2.12639.
Kittleson MM. Who is the Candidate? The Heart Transplant Evaluation Process. Methodist Debakey Cardiovasc J. 2025 May 15;21(3):13-24. doi: 10.14797/mdcvj.1512. PMID: 40384741; PMCID: PMC12082443.
Yael Peled, MD; Anique Ducharme, MD, MSc; Michelle Kittleson, at el. ISHLT Guidelines for the Evaluation and Care of Cardiac Transplant Candidates -2024, J Heart Lung Transplant. August 2024. F Frutos Seminario, J Gonzalez-Costello, C Diez-Lopez, N Manito, J Roca, J C Sanchez-Salado, F Sbraga, U Lopez-Cardozo, E Garcia-Romero, A Ariza-Sole, V Lorente, A Miralles, A Blasco, I Tatjer, A Cequier, P2810
Szymańska S, Grajkowska W, Pronicki M. Pathologic diagnosis of antibody-mediated rejection in endomyocardial biopsy after heart transplantation based on renewed International Society for Heart and Lung Transplantation criteria. Pol J Pathol. 2014 Oct;65(3):176-81. doi: 10.5114/pjp.2014.45785. PMID: 25372414.
Kieviet LC, Muller SA, Szymanski MK, van der Meer MG, Handoko ML, Rittersma SZH, de Jager SCA, van Aarnhem EE, Vos A, van der Harst P, van Laake LW, Oerlemans MIFJ. Clinical relevance and outcome of routine endomyocardial biopsy to detect rejection after heart transplantation. JHLT Open. 2025 Jun 14;9:100320. doi: 10.1016/j.jhlto.2025.100320. PMID: 40678362; PMCID: PMC12269405.
White JA, Guiraudon C, Pflugfelder PW, Kostuk WJ. Routine surveillance myocardial biopsies are unnecessary beyond one year after heart transplantation. J Heart Lung Transplant. 1995 Nov-Dec;14(6 Pt 1):1052-6. PMID: 8719450.
K. Antończyk, T. Niklewski, R. Antończyk, M. Zakliczyński, M. Zembala, T. Kukulski, Speckle-Tracking Echocardiography for Monitoring Acute Rejection in Transplanted Heart,Transplantation Proceedings, Volume 50, Issue 7,2018,Pages 2090-2094,ISSN 0041-1345,https://doi.org/10.1016/j.transproceed.2018.03.112.
S Anand, P Young, H Alnsasra, S Shrivastava, R Asleh, K Murphy, B Smith, W Kremers, S Kushwaha, A Clavell, D.E Steidley, N Pereira, L.M Lemond, Utilization of cardiac MRI for the assessment of suspected rejection with negative biopsy in heart transplant recipients, European Heart Journal, Volume 41, Issue Supplement_2, November 2020, ehaa946.1114, https://doi.org/10.1093/ehjci/ehaa946.1114
Khubutiya M.Sh., Gilyarevsky S.R., Sokolov V.V., Kovaleva E.V., Kuzmina I.M., Boychevskaya E.I. Modern approaches to the selection of patients for heart transplantation. Transplantologiya. 2010;(3-4). URL: https://cyberleninka.ru/article/n/sovremennye-podhody-k-otboru-bolnyh-dlya-transplantatsii-serdtsa.
Immohr MB, Akhyari P, Böttger C, et al. Levosimendan for Treatment of Primary Graft Dysfunction After Heart Transplantation: Optimal Timing of Application. Exp Clin Transplant. 2021;19(6):554-561. doi:10.6002/ect.2020.0454. PMID: 33877035.
Pérez Vela JL, Corres Peiretti MA, Renes Carreño E, et al. Levosimendan for Postoperative Ventricular Dysfunction Following Heart Transplantation. Rev Esp Cardiol. 2008;61(5):534-537. doi:10.1016/S1885-5857(08)60178-4. PMID: 18462660.
Jia YX, Meng X, Sun LB, Han J, Chen YT. Using intramyocardial electrograms combined with other noninvasive methods for monitoring acute rejection following human heart transplantation. Chin Med J (Engl). 2009 Jan 20;122(2):160-5. PMID: 19187638. DOI: 10.3760/cma.j.issn.0366-6999.2009.02.004.
Goncharenko MM, et al. Clinical and laboratory characteristics of recipients during orthotopic heart transplantation according to intraoperative monitoring. J Heart Lung Transplant. 2024;43(10):1719-1728. doi:10.1016/j.healun.2023.09.013
Thermodilution Cardiac Index Has Poor Agreement with That Measured by the Direct Fick Method in Low-Output States. J Card Fail. 2021;27(10):1126-1132. doi:10.1016/j.cardfail.2021.05.016
Hogue CW, Nomura Y, Barodka VM, et al. Validation of a Real-Time Minute-to-Minute Urine Output Monitor and the Feasibility of Its Clinical Use for Patients Undergoing Cardiac Surgery. Anesth Analg. 2018;126(4):1138-1144. doi:10.1213/ANE.0000000000002541
Romano P, et al. The role of intraoperative transesophageal echocardiography in heart transplantation. Echocardiography. 2002;19(7 Pt 1):599-604. doi:10.1046/j.1540-8175.2002.00599.x
Chang AJ, Nomura Y, Barodka VM, et al. Validation of a Real-Time Minute-to-Minute Urine Output Monitor and the Feasibility of Its Clinical Use for Patients Undergoing Cardiac Surgery. Anesth Analg. 2018;126(4):1138-1144. doi:10.1213/ANE.0000000000002541
Goldraich LA, et al. A Comprehensive and Contemporary Review on Immunosuppression Therapy for Heart Transplantation. Curr Pharm Des. 2020;26(28):3351-3384. doi: 10.2174/1381612826666200603130232. PMID: 32493185
Nikolova AP, et al. Practical Guide on the Use of Induction Immunosuppression in Heart Transplantation. Circ Heart Fail. 2025;18(10):e012382. doi: 10.1161/CIRCHEARTFAILURE.124.012382
Czer LS, et al. Antithymocyte Globulin Induction Therapy Adjusted for Immunologic Risk After Heart Transplantation. Transplant Proc. 2013;45(6):2393-2398. doi: 10.1016/j.transproceed.2013.02.114. PMID: 23953554
Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo MA, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings DL, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2023 May;42(5):e1-e141. doi: 10.1016/j.healun.2022.10.015. Epub 2022 Dec 20. PMID: 37080658.
Elboudwarej O, Phan D, Patel JK, Liou F, Aintablian T, Osborne A, Yu Z, Reinsmoen N, Kobashigawa JA. Corticosteroid wean after heart transplantation-Is there a risk for antibody formation? Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12916. Epub 2017 Feb 20. PMID: 28135788.
Joseph Rabin, David J. Kaczorowski, Perioperative Management of the Cardiac Transplant Recipient, Critical Care Clinics, Volume 35, Issue 1, 2019, Pages 45-60, ISSN 0749-0704, ISBN 9780323654630, https://doi.org/10.1016/j.ccc.2018.08.008.
Waser M, Maggiorini M, Lüthy A, Laske A, von Segesser L, Mohacsi P, Opravil M, Turina M, Follath F, Gallino A. Infectious complications in 100 consecutive heart transplant recipients. Eur J Clin Microbiol Infect Dis. 1994 Jan;13(1):12-8. doi: 10.1007/BF02026117. PMID: 8168553.
Chesnikova A. I., Sitnikova M. Y., Ageev F. T., Arutyunov G. P., Bautin A. E., Begrambekova Y. L., Belenkov Y. N., Vasyuk Y. A., Vinogradova N. G., Galyavich A. S., Garganeeva A. A., Gendlin G. E., Gilyarevsky S. R., Glezer M. G., Gordeev M. L., Gautier S. V., Gudkova A. Y., Drapkina O. M., Demchenko E. A., Irtyuga O. B., Kobalava Z. D., Koziolova N. A., Kostareva A. A., Kuzheleva E. A., Lopatin Yu. M., Mareev Yu. V., Melekhov A. V., Mitrofanova L. B., Mikhailov E. N., Moiseeva O. M., Nikulina S. Yu., Obrezan A. G., Orlova Ya. A., Safronenko V. A., Tarlovskaya E. I., Fedotov P. A., Fomin I. V., Chernova A. A., Shaposhnik I. I., Shlyakhto E. V. Dilated cardiomyopathy. Clinical guidelines 2025. Russian Journal of Cardiology.2026;31(5):6672. doi: 10.15829/1560-4071-2026-6672. EDN: DBDNKD
Barbarash O.L., Karpov Yu.A., Panov A.V., Akchurin R.S., Alekyan B.G., Alekhin M.N., Aronov D.M., Arutyunyan G.K., Belenkov Yu.N., Boytsov S.A., Boldueva S.A., Boshchenko A.A., Bubnova M.G., Bulkina O.S., Vasyuk Yu.A., Galyavich A.S., Glezer M.G., Golubev E.P., Golukhova E.Z., Grinshteyn Yu.I., Davidovich I.M., Ezhov M.V., Zavadovsky K.V., Irtyuga O.B., Karpov R.S., Kashtalap V.V., Koziolova N.A., Korennova O.Yu., Kosmacheva E.D., Koshelskaya O.A., Kukharchuk V.V., Lopatin Yu.M., Merkulov E.V., Mironov V.M., Martsevich S.Yu., Mirolyubova O.A., Mikhin V.P., Nedoshivin A.O., Nikulina N.N., Nikulina S.Yu., Oleynikov V.E., Panchenko E.P., Perepech N.B., Petrova M.M., Protasov K.V., Saidova M.A., Samko A.N., Sergienko I.V., Sinitsyn V.E., Skibitsky V.V., Soboleva G.N., Shalaev S.V., Shaposhnik I.I., Shevchenko A.O., Shiryaev A.A., Shlyakhto E.V., Chumakova G.A., Yakushin S.S. Stable coronary artery disease. Clinical guidelines 2024. Russian Journal of Cardiology. 2024;29(9):6110. https://doi.org/10.15829/1560-4071-2024-6110. EDN: HHJJUT
Bokeria L.A., Shlyakhto E.V., Gabrusenko S.A., Gudkova A.Ya., Koziolova N.A., Alexandrova S.A., Alekhin M.N., Afanasyev A.V., Bogatyreva M.M., Bogachev-Prokofiev A.V., Bogdanov D.V., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Evtushenko A.V., Zaklyazminskaya E.V., Zenchenko D.I., Irtyuga O.B., Kaplunova V.Yu., Kashtanov M.G., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Rud S.D., Rybka M.M., Saidova M.A., Streltsova A.A., Stukalova O.V., Chmelevsky M.P., Shaposhnik I.I., Shloydo E.A. Hypertrophic cardiomyopathy. Clinical guidelines 2025. Russian Journal of Cardiology. 2025;30(5):6387. https://doi.org/10.15829/1560-4071-2025-6387. EDN: BUUCJT
Alain Heroux, Salpy V. Pamboukian, Chapter 82 - Neurologic aspects of heart transplantation, Editor(s): José Biller, José M. Ferro, Handbook of Clinical Neurology, Elsevier, Volume 121, 2014, Pages 1229-1236, ISSN 0072-9752, ISBN 9780702040887, https://doi.org/10.1016/B978-0-7020-4088-7.00082-1.
Wei J and Zhou Y (2021) Association of Thyroid-Stimulating Hormone (TSH) Levels With the Prognosis of Patients Undergoing Heart Transplantation: A Retrospective Study. Front. Cardiovasc. Med. 8:720922. doi: 10.3389/fcvm.2021.720922
Nagy A Holndonner-Kirst E, Eke C, Szecsi B, Szabo A, Plamondon M J et al. Perioperative low tetraiodothyronine levels and adverse outcomes after heart transplantation: a retrospective, observational study. J Cardiothorac Vasc Anesth. (2020) 34:2648–54. 10.1053/j.jvca.2020.03.052
Taipale MA, Pentikäinen MO, Martelius LA, Mutka A, Kytölä SI, Kankainen M, Peltonen JI, Syrjälä SO, Lahtiharju AJI, Lommi JJ, Jahnukainen TJ, Lemström KB, Ojala TH. Cardiac magnetic resonance in heart transplant recipients: histological, clinical and cell-free DNA validation. Eur Heart J Cardiovasc Imaging. 2025 Jul 31;26(8):1420-1428. doi: 10.1093/ehjci/jeaf145. PMID: 40384031; PMCID: PMC12311155.
Knollmann FD, Hummel M, Hetzer R, Felix R. CT of heart transplant recipients: spectrum of disease. Radiographics. 2000 Nov-Dec;20(6):1637-48. doi: 10.1148/radiographics.20.6.g00nv011637. PMID: 11112818.
Shevchenko A.O., Tyunyaeva I.Yu., Lysenko M.M., Koloskova N.N., Muminov I.I., Zakharevich N.Yu. Prognostic value of the non-invasive common carotid artery wall elasticity index in heart recipients. Russian Journal of Transplantology and Artificial Organs. 2024;26(3):141-146. https://doi.org/10.15825/1995-1191-2024-3-141-146
Rabbath X, Pelletier-Galarneau M, Tremblay-Gravel M, Noly PE, Racine N, Tan S. Value of CT and 18F-FDG PET/CT Imaging for Preoperative Screening in Advanced Heart Failure Therapy Candidates. CJC Open. 2023 Mar 30;5(6):415-420. doi: 10.1016/j.cjco.2023.03.012. PMID: 37397610; PMCID: PMC10314147.
Park YM, Kim JH, Baik SJ, Park JJ, Youn YH, Park H. Clinical risk assessment for gastric cancer in asymptomatic population after a health check-up: An individualized consideration of the risk factors. Medicine (Baltimore). 2016 Nov;95(44):e5351. doi: 10.1097/MD.0000000000005351. PMID: 27858920; PMCID: PMC5591168.
The Forrester classification. Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, Chabanne C, Delmas C, D'Ostrevy N, Epailly E, Gariboldi V, Gaudard P, Goéminne C, Grosjean S, Guihaire J, Guillemain R, Mattei M, Nubret K, Pattier S, Pozzi M, Rossignol P, Vermes E, Sebbag L, Girerd N. Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation. ESC Heart Fail. 2022 Oct;9(5):3287-3297. doi: 10.1002/ehf2.14037. Epub 2022 Jul 7. PMID: 35801277; PMCID: PMC9715881.
Mohammadpour N, Elyasi S, Vahdati N, Mohammadpour AH, Shamsara J. A review on therapeutic drug monitoring of immunosuppressant drugs. Iran J Basic Med Sci. 2011 Nov;14(6):485-98. PMID: 23493821; PMCID: PMC3586862.
Muminov I.I., Koloskova N.N., Poptsov V.N., Zakharevich V.M., Mozheyko N.P., Sakhovsky S.A., Shevchenko A.O. Experience of outpatient follow-up of heart transplant recipients at the Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs. Russian Journal of Transplantology and Artificial Organs. 2023;25(3):68-75. https://doi.org/10.15825/1995-1191-2023-3-68-75 LRM 4 LOC R (adults)
Simonenko M, Hansen D, Niebauer J, Volterrani M, Adamopoulos S, Amarelli C, Ambrosetti M, Anker SD, Bayes-Genis A, Ben Gal T, Bowen TS, Cacciatore F, Caminiti G, Cavarretta E, Chioncel O, Coats AJS, Cohen-Solal A, D'Ascenzi F, de Pablo Zarzosa C, Gevaert AB, Gustafsson F, Kemps H, Hill L, Jaarsma T, Jankowska E, Joyce E, Krankel N, Lainscak M, Lund LH, Moura B, Nytrøen K, Osto E, Piepoli M, Potena L, Rakisheva A, Rosano G, Savarese G, Seferovic PM, Thompson DR, Thum T, Van Craenenbroeck EM. Prevention and Rehabilitation After Heart Transplantation: A Clinical Consensus Statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a Section of ESOT. Transpl Int. 2024 Jun 19;37:13191. doi: 10.3389/ti.2024.13191. PMID: 39015154; PMCID: PMC11250379.
Appendix A1. Working Group Composition
Gichkun Olga Evgenyevna | Leading Researcher, Department of Regulatory Mechanisms in Transplantology, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Candidate of Medical Sciences, Associate Professor |
Sergey Vladimirovich Gautier | Director of the Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Academician of the Russian Academy of Sciences, Chief Transplantologist of the Russian Ministry of Health, Chairman of the Russian Transplant Society, D.Sc. (Medicine), Professor, Academician of the Russian Academy of Sciences |
Zainutdinov Zainudin Musayevich | Head of the Clinic, Federal Research Center of Nutrition and Biotechnology (Moscow), Doctor of Medical Sciences |
Vyacheslav Mefodyevich Zakharevich | Head of Cardiac Surgery Department No. 3, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences |
Natalya F. Klimusheva | Deputy Chief Medical Officer for Inpatient Care, Sverdlovsk Regional Clinical Hospital No. 1, Chief Freelance Transplantologist of the Russian Ministry of Health in the Ural Federal District (Yekaterinburg), Doctor of Medical Sciences |
Nadezhda N. Koloskova | Head of Cardiology Department, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences |
Vyacheslav L. Korobka | Chief Medical Officer, Rostov Regional Clinical Hospital (Rostov-on-Don), Chief Transplantologist of Rostov Region, Doctor of Medical Sciences |
Marina G. Minina | Deputy Chief Medical Officer, Head of the Moscow Organ Donation Coordination Center, S.P. Botkin City Clinical Hospital of the Moscow Healthcare Department (Moscow), Doctor of Medical Sciences, Professor of the Russian Academy of Sciences |
Boris L. Mironkov | Head of the Department of X-ray Endovascular Diagnostic and Treatment Methods, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences, Professor |
Mozheyko Natalya Pavlovna | Head of the Department of Pathology, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences |
German V. Nikolayev | Head of the Research Laboratory of Thoracic Surgery, V.A. Almazov National Medical Research Center of the Russian Ministry of Health, Thoracic Surgeon, Chief Freelance Transplantologist of the St. Petersburg Health Committee (St. Petersburg), Candidate of Medical Sciences |
Yury P. Ostrovsky | Deputy Director for Innovative Development and High Technologies, Republican Scientific and Practical Center for Cardiology (Minsk, Republic of Belarus), Doctor of Medical Sciences, Professor, Academician of the National Academy of Sciences of Belarus |
Vladimir A. Porkhanov | Chief Medical Officer, Research Institute - Professor S.V. Ochapovsky Regional Clinical Hospital No. 1 of the Ministry of Health of Krasnodar Krai (Krasnodar), Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences |
Ekaterina A. Spirina | Acting Head of Department - Anesthesiologist-Resuscitologist, Departments of Anesthesiology, Resuscitation and Intensive Care, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Candidate of Medical Sciences |
Timur A. Khalilulin | Deputy Director for Medical Care - Cardiovascular Surgeon, Cardiac Surgery Department No. 3, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences |
Sergey M. Khomyakov | Deputy Director - Head of the Center for Organizational and Methodological Guidance of Institutions Performing Activities Related to Human Organ and/or Tissue Transplantation, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Candidate of Medical Sciences |
Olga M. Tsirulnikova | Physician of the Therapeutic Department, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health, Professor of the Department of Transplantology and Artificial Organs, I.M. Sechenov First Moscow State Medical University of the Russian Ministry of Health (Sechenov University) (Moscow), Doctor of Medical Sciences, Professor |
Konstantin V. Shatalov | Head of the Department of Emergency Surgery for Congenital Heart Defects with an Assisted Circulation Group, Deputy Director for Scientific Work, A.N. Bakulev National Medical Research Center for Cardiovascular Surgery (Moscow), Doctor of Medical Sciences, Professor |
Alexey O. Shevchenko | Deputy Chief Medical Officer, O.M. Филатов City Clinical Hospital No. 15 of the Moscow Healthcare Department, Chief Researcher, Center for Personalized Translational Technologies for Critical Care Treatment, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences |
Olga P. Shevchenko | Deputy Director for Scientific Work, Head of the Department of Regulatory Mechanisms in Transplantology, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Doctor of Medical Sciences, Professor |
Natalya P. Shmerko | Head of the Clinical Diagnostic Laboratory and Immunological Monitoring Laboratory, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Russian Ministry of Health (Moscow), Candidate of Medical Sciences |
Conflict of interest.
The working group declares no conflict of interest.
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience of these clinical guidelines:
Medical specialists in the following fields:
Cardiologist
General Practitioner
General Practitioner (Family Physician)
Anesthesiologist-Resuscitologist
Pediatric Cardiologist
Pathologist
Cardiovascular Surgeon
X-ray Endovascular Diagnostics and Treatment Physician
Methods used for evidence collection/selection: electronic database searches.
Classification of recommendations and levels of evidence
Table No. 6. Scale for assessing levels of evidence (LE) for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference standard control or systematic reviews of randomized controlled trials with meta-analysis |
2 | Individual studies with reference standard control or individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis |
3 | Studies without sequential reference-standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table No. 7. Scale for assessing levels of evidence (LE) for prevention, medical rehabilitation methods, including those based on natural therapeutic factors (preventive, therapeutic, rehabilitation interventions)
LoE | Definition |
|---|---|
1 | Systematic review of RCTs with meta-analysis |
2 | Individual RCTs and systematic reviews of studies of any design except RCTs, with meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table No. 8. Scale for assessing levels of recommendation (LR) for prevention, diagnostic, treatment, and medical rehabilitation methods, including those based on natural therapeutic factors (preventive, therapeutic, rehabilitation interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent) |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Procedure for updating clinical guidelines
The clinical guideline update mechanism provides for their systematic revision at least once every three years, or whenever new information regarding the management tactics for patients with this disease becomes available, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
Current instructions for medical product use are available on the official website of the Russian Ministry of Health http://grls.rosminzdrav.ru/Default.aspx
Federal Law No. 323-FZ of November 21, 2011, 'On the Fundamentals of Protecting Public Health in the Russian Federation', Article 47. Donation of Human Organs and Tissues and Their Transplantation (Grafting)
Order of the Russian Ministry of Health No. 567n of October 31, 2012, 'On Approval of the Procedure for Providing Medical Care in the Field of Surgery (Human Organ and/or Tissue Transplantation)'
Order of the Russian Ministry of Health No. 182n of April 11, 2025, 'On Approval of the Instructions for Issuing a Medical Organization's Medical Board Conclusion on the Necessity of Human Organ and/or Tissue Transplantation and the Form of the Said Medical Conclusion'
Decree of the Government of the Russian Federation No. 2188 of December 29, 2025, 'On the Program of State Guarantees of Free Medical Care for Citizens for 2026 and for the Planning Period of 2027 and 2028'
Typical symptoms and clinical signs of cardiac graft rejection:
Symptoms | Clinical features |
|---|---|
|
|
Appendix B. Physician Action Algorithms
Algorithm for patient selection and preparation for heart transplantation
Appendix C. Patient Information
What is a heart transplantation?
Orthotopic heart transplantation is a universally recognized gold standard for the treatment of end-stage heart failure, significantly improving prognosis and quality of life. The procedure involves replacing the patient's damaged, non-viable organ with a donor organ. In our country, such surgeries have been performed since 1987.
An implantable ventricular assist device can be an effective alternative for a number of patients or can be used as a "bridge" in patients awaiting heart transplantation.
How is a heart transplantation performed?
Based on a comprehensive examination, physicians select the most optimal treatment strategy, and if a decision is made to perform a heart transplantation, the patient is placed on the waiting list and provided with recommendations regarding treatment and lifestyle during the waiting period.
How is the surgery performed?
Heart transplantation surgery is completely painless for the patient. Although the surgery itself may last many hours, the patient feels neither pain nor discomfort because they are asleep under the influence of a combination of medications.
After waking up, the patient spends several days in the intensive care unit and, as soon as their condition permits, is transferred to the cardiology and cardiac surgery department, where they will stay for another two to three weeks.
During the early postoperative period, the patient recovers under medical supervision and undergoes necessary examinations to evaluate graft function and prevent potential postoperative complications. Immunosuppressive therapy is also initiated and adjusted during this time.
How to live with a transplanted heart?
Heart transplantation restores the patient's physical and social activity. However, patients must continuously take prescribed medications and regularly undergo preventive examinations according to an individual plan, which, nevertheless, does not significantly affect their ability to work and live a full, active life.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
Appendix G1. New York Heart Association (NYHA) Functional Classification of Heart Failure.
Russian name: NYHA Functional Classification of Heart Failure (NYHA)
Original name (if any): the New York Heart Association (NYHA) Functional Classification
Source: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of- heart-failure
Type: rating scale
Purpose: classification of heart failure by functional class
Content:
Table No. 9. New York Heart Association (NYHA) Functional Classification of Heart Failure
Functional class | Characteristics |
|---|---|
I | Heart disease does not limit physical activity. Ordinary physical activity is not accompanied by pronounced dyspnea, fatigue, or palpitations. |
II | Heart disease results in a slight limitation of physical activity. Symptoms are absent at rest. Ordinary physical activity causes pronounced dyspnea, fatigue, or palpitations. |
III | Heart disease results in a marked limitation of physical activity. Symptoms are absent at rest. Less than ordinary activity causes pronounced dyspnea, fatigue, or palpitations. |
IV | Heart disease results in a severe limitation of any physical activity. Symptoms may be present at rest. Symptoms worsen with any physical activity. |
Appendix G2. Strazhesko and Vasilenko classification of chronic heart failure (1935)
Russian name: Strazhesko and Vasilenko Classification of Heart Failure (1935)
Original name (if any): Strazhesko and Vasilenko
Classification of Heart Failure (1935)
Source: Clinical Guidelines for the Diagnosis and Treatment of Heart Failure 2009 (Third Revision) by the Society of Heart Failure Specialists and the Association of Cardiologists
Type: rating scale
Purpose: assessment of chronic circulatory failure
Content:
Table No. 10. Strazhesko and Vasilenko Classification of Heart Failure (1935)
Stage | Stage | Clinical and morphological characteristics |
|---|---|---|
Stage I (initial) | Hemodynamic changes are absent at rest and are detected only upon physical exertion. | |
Stage II | Hemodynamic disorders in the form of blood congestion in the pulmonary and/or systemic circulation persist at rest. | |
Stage IIA | Signs of heart failure at rest are moderately pronounced. Hemodynamics is impaired in only one part of the cardiovascular system (pulmonary or systemic circulation). | |
Stage IIB | Conclusion of the prolonged progression stage of heart failure. Marked hemodynamic disorders involving the entire cardiovascular system (both pulmonary and systemic circulation). | |
Stage III | Severe hemodynamic disorders and signs of venous congestion in both circulations, as well as significant impairment of perfusion and metabolism in organs and tissues. | |
Appendix G3. Killip classification of acute heart failure
Russian name: Killip Classification of Acute Heart Failure Killip
Original name (if any): The Killip classification
Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967;20(4):457–64.
Type: rating scale
Purpose: assessment of acute heart failure
Content:
Table No. 11. Killip Classification of Acute Heart Failure
Class | Characteristics |
|---|---|
I | No symptoms and signs of heart failure |
II | Heart failure characterized by rales occupying no more than half of the lung field, third heart sound, and venous pulmonary hypertension |
III | Pulmonary edema (rales occupy more than half of the lung field) |
IV | Cardiogenic shock |
Appendix G4. Forrester Classification of Acute Heart Failure Based on Central Hemodynamics
Russian name: Forrester Classification of Acute Heart Failure Based on Central Hemodynamics
Original name (if any): The Forrester classification
Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, Chabanne C, Delmas C, D'Ostrevy N, Epailly E, Gariboldi V, Gaudard P, Goéminne C, Grosjean S, Guihaire J, Guillemain R, Mattei M, Nubret K, Pattier S, Pozzi M, Rossignol P, Vermes E, Sebbag L, Girerd N. Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation. ESC Heart Fail. 2022 Oct;9(5):3287-3297. doi: 10.1002/ehf2.14037. Epub 2022 Jul 7. PMID: 35801277; PMCID: PMC9715881.
Type: rating scale
Purpose: assessment of acute heart failure based on central hemodynamics
Content:
Table No. 12. Forrester Classification of Acute Heart Failure Based on Central Hemodynamics
Class | PCWP (mm Hg) | CI (L/min/m2) | Clinical manifestations |
|---|---|---|---|
I | <18 | >2,2 | Normal |
II | >18 | >2,2 | Pulmonary congestion |
III | <18 | <2,2 | Hypovolemia, RV failure, arteriolar dilatation |
IV | >18 | <2,2 | LV failure, cardiogenic shock |
Appendix G5. Classification of acute cellular rejection (ISHLT 2004)
Russian title: Classification of Acute Cellular Rejection (ISHLT 2004)
Original title (if available): ISHLT 2004 Acute Cellular Rejection Grading Scheme
Type: rating scale
Purpose: assessment of acute cellular rejection in endomyocardial biopsy specimens
Content:
Table 13. Classification of Acute Cellular Rejection (ISHLT 2004)
Grades | Morphological findings |
|---|---|
Grade 1R | Myocardial mononuclear infiltration with or without a single focus of cardiomyocyte damage |
Grade 2R | Myocardial mononuclear infiltration with multiple foci of cardiomyocyte damage |
Grade 3R | Mononuclear infiltration with diffuse cardiomyocyte damage and/or signs of edema, hemorrhage, or vasculitis |
Appendix G6. Classification of Acute Antibody-Mediated Rejection (ISHLT 2013)
Russian title: Classification of Acute Humoral Rejection (ISHLT 2013)
Original title (if available): ISHLT 2013 Acute Humoral Rejection Grading
Scheme https://www.ishlt.org/
Type: rating scale
Purpose: assessment of acute humoral rejection in endomyocardial biopsy specimens
Content:
Table 14. Classification of Acute Humoral Rejection (ISHLT 2013)
Grades | Morphological findings |
|---|---|
pAMR0 | No histologic and immunohistochemical signs |
pAMR-1 (I+) | Presence of immunofluorescence signs only: C4d complement component in the walls of interstitial vascular capillaries |
pAMR-1 (H+) | Presence of histologic signs only: vascular endothelial activation, perivascular cellular infiltrate, perivascular intravascular macrophages, interstitial edema, possible cardiomyocyte necrosis |
pAMR-2 | Combination of histologic and immunofluorescence signs (pAMR (H+) + pAMR (I+) = pAMR2) |
pAMR-3 | Pronounced histologic signs and widespread C4d complement component staining in the myocardial capillary walls |
Appendix G7. Classification of Cardiac Allograft Vasculopathy (ISHLT 2010)
Russian title: Classification of Cardiac Allograft Vasculopathy (ISHLT 2010)
Original title (if available): https://www.ishlt.org/
Type: rating scale
Purpose: assessment of cardiac allograft vasculopathy based on
angiographic examination
Content:
Table 15. Classification of Cardiac Allograft Vasculopathy (ISHLT 2010)
Grade | Angiographic criteria |
|---|---|
ISHLT CAV 0 (nonsignificant vasculopathy) | No angiographic changes detected |
ISHLT CAV 1 (mild) | Left main stenosis <50%, primary vessel stenosis <70%, or any branch stenosis <70% (including diffuse narrowing) without graft dysfunction |
ISHLT CAV 2 (moderate) | Left main stenosis >50%, primary vessel stenosis >70%, or any secondary branch stenosis >70% without graft dysfunction |
ISHLT CAV 3 (severe) | Left main stenosis >50%, stenosis of two or more primary vessels >70%, or any secondary branch stenosis >70% in all three major systems; or ISHLT CAV 1 or ISHLT CAV 2 combined with graft dysfunction (defined as LVEF <45%, usually combined with regional LV wall motion abnormalities), or signs of significant restrictive diastolic dysfunction |
Appendix G8. Determination of Urgency Status for Patients on the Heart Transplantation Waiting List (per UNOS)
Russian title: Determination of Urgency Status for Patients on the Heart Transplantation Waiting List (per UNOS)
Original title (if available): https://www.ishlt.org/
Type: rating scale
Purpose: degree of urgency for surgical intervention (heart transplantation) for a patient on the waiting list
Content:
Table 16. Determination of Urgency Status for Patients on the Heart Transplantation Waiting List (per UNOS)
UNOS Status | Criteria |
|---|---|
1A |
|
1B | Patients on left and/or right ventricular mechanical circulatory support for more than 30 days without complications and/or requiring continuous infusion of inotropic agents other than cardiac glycosides at therapeutic doses |
2 | All other patients on the heart transplantation waiting list. |