Cardiac Transplantation : A Manual for Health Care Professionals

Over the past ten years, cardiac transplantation has evolved from an exper­ imental procedure performed in a handful of university centers to a viable therapeutic modality now performed in more than 150 centers worldwide. The complexity of the procedure, the changing immunosuppressive re­ gimes, and the follow-up care have necessitated a multidisciplinary ap­ proach involving a variety of medical, nursing, and social sciences special­ ties and subspecialties. In addition, health care trainees and referring physicians are increasingly becoming involved in the care of the cardiac transplant recipient. This book does not attempt to be a comprehensive treatise on cardiac transplantation; rather, we hope that it will serve as a manual and guideline for all health professionals involved in cardiac trans­ plantation. JEFFREY D. HOSENPUD, M.D. Contents Preface v Contributors IX 1. Cardiac Transplantation: An Overview JEFFREY D. HOSENPUD AND ALBERT STARR Immunogenetics and Immunologic Mechanisms of 2. Rejection 15 DOUGLAS J. NORMAN 3. Medical Therapy Tailored for Advanced Heart Failure 33 LYNNE WARNER STEVENSON 4. Ventricular Assistance as a Bridge to Cardiac Transplantation 53 D. GLENN PENNINGTON AND MARC T. SWARTZ Recipient Selection for Cardiac Transplantation 71 5. GEORGE A. PANTELY 6. Donor Selection and Management for Cardiac Transplantation 85 JEFFREY SWANSON AND ADNAN COBANOGLU 7. Operative Techniques and Early Postoperative Care in Cardiac Transplantation 95 ADNAN COBANOGLU Endomyocardial Biopsy: Techniques and Interpretation of 8. Front Matter....Pages i-x Cardiac Transplantation: An Overview....Pages 1-13 Immunogenetics and Immunologic Mechanisms of Rejection....Pages 15-31 Medical Therapy Tailored for Advanced Heart Failure....Pages 33-51 Ventricular Assistance as a Bridge to Cardiac Transplantation....Pages 53-70 Recipient Selection for Cardiac Transplantation....Pages 71-84 Donor Selection and Management for Cardiac Transplantation....Pages 85-93 Operative Techniques and Early Postoperative Care in Cardiac Transplantation....Pages 95-114 Endomyocardial Biopsy: Techniques and Interpretation of Rejection....Pages 115-137 Chronic Immunosuppression and the Treatment of Acute Rejection....Pages 139-168 Physiology and Hemodynamic Assessment of the Transplanted Heart....Pages 169-189 Medical Complications in Patients after Cardiac Transplantation....Pages 191-211 Psychiatric Considerations in the Cardiac Transplant Recipient....Pages 213-231 Back Matter....Pages 233-265 This multi-disciplinary approach to cardiac transplantation reflects the many different aspects of the medical, nursing and social sciences that come into play. It contains practical information for all members of the transplantation team - from surgeon to resident to nurse. The clinical information includes the protocols developed at the Oregon Health Sciences Center. The literature on which their experience is based is also reviewed. The chapters give an overview of aspects such as ventricular assistance, recipient/donor selection, endomyocardial biopsy, immuno-suppressive regimes, and follow-up care. The book does not attempt to be a comprehensive treatise on surgical techniques; instead it is a clear and understandable manual for all medical professionals dealing with the cardiac transplant patient. A practical manual (including protocols) that discusses aspects of cardiac transplantation for the surgeon, clinical staff, nurses, psychiatrists, and others involved in care of the cardiac transplant patient which is not limited to surgical procedures.