Kao W, Winkel E, Costanzo M R
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Curr Opin Cardiol. 1995 Mar;10(2):159-68. doi: 10.1097/00001573-199503000-00011.
Because of the increasing discrepancy between the number of identified candidates for heart transplantation and available donor organs, appropriate selection of patients for heart transplantation is critical. The establishment of a cardiac prognosis that is significantly worse than that following heart transplant is central in the determination of candidacy for transplantation. However, with recent improvements in heart failure management, prognosis must be considered a dynamic state involving periodic reassessment to ensure an individual's ongoing suitability for transplantation. There have been many descriptions of prognostic indexes in heart failure, but care must be used when extrapolating observations collected from patients with a broad range of conditions to those with end-stage disease. The contraindications to heart transplantation have also evolved with the increasing success of the transplant process. Many conditions that precluded patients from heart transplant in the past are no longer regarded as absolute. Despite less stringent conditions for recipient candidacy, the need to achieve optimal results with an increasingly valuable donor resource will necessitate careful scrutiny of the posttransplant implications of the various conditions currently regarded as contraindications to heart transplant. Determination of heart transplantation candidacy therefore continues to remain a highly individualized process, requiring clinical judgment and experience.
由于心脏移植候选者数量与可用供体器官数量之间的差距日益增大，因此合理选择心脏移植患者至关重要。确立显著差于心脏移植后的心脏预后是确定移植候选资格的核心。然而，随着近期心力衰竭管理的改善，预后必须被视为一个动态过程，需要定期重新评估，以确保个体持续适合移植。心力衰竭的预后指标已有很多描述，但在将从广泛病情患者中收集的观察结果外推至终末期疾病患者时必须谨慎。随着移植手术成功率的提高，心脏移植的禁忌症也有所演变。过去许多使患者无法进行心脏移植的情况如今不再被视为绝对禁忌。尽管受体候选资格的条件不再那么严格，但要利用日益宝贵的供体资源取得最佳效果，就必须仔细审视目前被视为心脏移植禁忌症的各种情况对移植后情况的影响。因此，确定心脏移植候选资格仍然是一个高度个体化的过程，需要临床判断和经验。
