critical care of heart transplantation. heart transplant 1960s: first heart transplants performed...

Critical Care of Heart Transplantation

Heart Transplant1048708 1960s

1048708 First heart transplants performed

1048708 1980s

1048708 Anti-rejection meds became available (Cyclosporine)

1048708 Today

1048708 About 80 of heart transplants are alive two years after the operation

1048708 50 percent survive 5 years

042123 2dr yekehfallah-phd of nursing -2015

Clinical Indications forHeart Transplant

1048708 Ischemic cardiomyopathy

1048708 Idiopathic cardiomyopathy

1048708 Viral cardiomyopathy

1048708 Congenital heart disease

1048708 Valvular heart disease


Heart Transplant Contraindications

Absolute ContraindicationsI A Systemic illness that will limit survival despite heart

translplantII NeoplasmIII HIVAIDS CDC definition of CD4 count of lt 200 cellsmm3

IV SLE or Sarcoid that has multisystem involvement and is still active

V Any systemic illness with a high probability of recurrence in the transplanted heart

VI B Fixed pulmonary hypertension


Heart Transplant Contraindications Relative Contraindications

Age over 65 Peripheral vascular disease Asymptomatic carotid stenosis gt 75 or symptomatic

carotid stenosis of less severity

Uncorrected abdominal aortic aneurysm gt 4 ndash 6 cm Systemic infection making immune suppression risky

HIV HBV CMV (positive donor to negative recipient) Severe pulmonary disease


Transplant Evaluation

1048708 Left andor Right Heart Catherization

1048708 Echocardiogram

1048708 EKG

1048708 24 hour Holter Monitor

1048708 Carotid and peripheral doppler flow studies

1048708 Cardiopulmonary Stress Test

1048708 Metabolic exercise test that determines the

maximal oxygen consumption



1048708 Pulmonary

1048708 Chest radiograph

1048708 CT Chest

1048708 PFTrsquos ndash baseline screening spirometry



1048708 Renal

1048708 Urinalysis

1048708 24 hour urine for creatinine clearance

1048708 Renal ultrasound

1048708 Gastrointestinal

1048708 Stool guiac

1048708 Abdominal ultrasound

1048708 CT abdominal and pelvis

1048708 Colonoscopy



1048708 Antibody screen

1048708 HLA typing

1048708 Infectious disease serologies

1048708 General laboratory studies

1048708 Bone density scan

1048708 Cancer screens ndash gender specific tests


Social Services Psychiatry NeuropsychiatryConsults and Evaluation

1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety

1048708 Substance abuse

1048708 Finances

1048708 Knowledge deficits


Medical Management of Patientson Waiting List

Comprehensive CHF Management

Program


Patient Education

1048708 Disease Process

1048708 Medication Use

1048708 Lifestyle Changes

1048708 Fluid Restriction

1048708 Sodium Restriction

1048708 Pre Transplant Immunizations

1048708 Clinic Follow up


Donor Selection

Donor Factors Important for Organ Recovery1048708 Age lt 45years younger donors are better1048708 Hemodynamics - CVP1048708 CPR history ndashAny down time secondary to presumed

cardiac arrest1048708 Echo LVEF LV wall thickness ValvesAnomalies1048708 EKG ndash No Q waves1048708 Effect of high dose vasopressors

1048708 Traumatic injury to the heart


Donor Selection1048708 Negative serologies

1048708 No active systemic infection

1048708 No extracranial malignancies

1048708 No history IV drug use

1048708

1048708 Coronary Angiography for donors over

40yrs of age



042123 dr yekehfallah-phd of nursing -2015 16






Major Post Transplant Complications

Rejection Infection Cardiac allograft vasculopathy (CAV) Hypertension Nephrotoxicity Malignancy


Rejection Invasive surveillance biopsies are the best established method for following patients

Typically 13-15 biopsies are done in the first year

Each biopsy requires a minimum of 3 samples from 3 different sites to be meaningful

A new biopsy grading has been developed for widespread adoption




International Society For Heart and Lung TransplantationStandardized Grading For Cardiac Biopsies

Rejection grade Description0 No evidence of rejection

1 - Mild A - Focal

Focal perivascular andor interstitial infiltrate without myocyte damage

B - Diffuse Diffuse infiltrate without myocyte damage

2 - Moderate (focal) One focus of infiltrate with myocyte damage

3 - ModerateA - Multifocal

Multifocal infiltrate with myocyte damage

MultifocalB - Diffuse

Diffuse infiltrate with myocyte damage

4 - Severe Diffuse polymorphous infiltrate with extensive myocyte damage plusmn edema plusmn hemorrhage plusmn vasculitis

26042123 dr yekehfallah-phd of nursing -2015

GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy


Treatment of Rejection

Rejection without hemodynamic compromise

Oral prednisone (100 mg daily for 3 days)

IV steroids

Decision dependent on grading severity and time post transplantation

Steroid resistant rejection with or without hemodynamic compromise

Cytolytic antibodies IVIG plasmapheresis photopheresis anti-B cell antibodies rapamycin methotrexate cyclophosphamide total lymphoid irradiation


Long Term Challenges

Renal failure and metabolic adverse effects

Cardiac allograft vasculopathy Malignancy



Heart Preservation Device1) Thermoelectric cooler2) Intermittent perfusion3) Preservation solution



Transmedics Inc


Heart Preservation Device2nd GenerationDevices


Postoperative TransplantManagement


Survival Following Transplant

1048708 Operative mortality rate is between 5-10

1048708 Other leading causes of mortality include1048708 Infection (15-20)

1048708 Acute RV failure

1048708 Rejection


Postoperative ManagementComplicated by

1048708 Denervation

1048708 Global ischemic injury associated with

perfusion injury

1048708 Myocardial dysfunction

1048708 Dysrhythmia

1048708 Hypertension

1048708 Pulmonary Hypertension


Infection Post Transplant

1048708 Prophylaxis

1048708 Viral - CMV

1048708 Pneumocystis carinii

1048708 Fungal

1048708 Based on recipient and donor serologies

bull Toxoplasmosis

bull TB

bull Cocci042123 39dr yekehfallah-phd of nursing -2015

TRANSPLANT REJECTION

1048708 Three types of transplant rejection

1048708 Hyperacute

1048708 Acute

1048708 Chronic


Signs of Rejection1048708 Edema1048708 Increased fatigue1048708 Intolerance of exercise1048708 Onset of low grade fever1048708 Increase in weight1048708 Exertional dyspnea1048708 Enlarged heart silhouette1048708 Rub (pericardial friction)1048708 EKG voltage decreased1048708 Jugular venous distention1048708 Cardiac dysrhythmias1048708 New S3 or S41048708 Onset of hypotension1048708 Echocardiogram changes1048708


Immunosuppression Balance


Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight

1048708 Blood pressure

1048708 Heart rate

1048708 Temperature

1048708 Blood sugar monitoring


Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG

1048708 Endomyocardial biopsy and or AlloMap


1048708 Bone Densitometry


Transplant Clinic Visits

1048708 Health Maintenance follow-up

1048708 Continuing education

1048708 Psychosocial issues


Cardiac Rehabilitation

1048708 Heart rate response to exercise is blunted and

delayed

1048708 Increase in heart rate is caused by circulating

catecholamines

1048708 Maximum heart rate is achieved after exercise is

completed

1048708 Deceleration of heart rate is gradual and

prolonged


Long Term Follow Up

Management and Complications


Medical Issues

1048708 Immunosuppression

1048708 Infection

1048708 Rejection

1048708 Coronary artery

vasculopathy


1048708 Hyperlipidemia

1048708 Diabetes

1048708 Osteoporosis

1048708 Obesity

1048708 Renal insufficiency

1048708 Gastrointestinal disorders

1048708 Reduced exercise

tolerance

1048708 Malignancy

1048708 Poor compliance

1048708 Depression


Quality of Life Issues

The functional effect of an illness and its

consequent therapy upon a patient as

perceived by the patient

bull Reproduction and Sexuality

bull Recurrent Disease

bull Travel

bull Adjustment


Mental and Emotional Health

1048708 Quality of Life

1048708 Psychiatric Disorders

1048708 Body Image

1048708 Social Adaptation

1048708 Family Dynamics

1048708 Financial Burdens


Return to Work vsDisability Issues

1048708 Insurance

1048708 Employment

1048708 Vocational Rehab

1048708 Disabilities


Yearly Evaluation

1048708 Cardiac catherization with Intravascular Ultrasound

1048708 Echo

1048708 Dobutamine Stress Echo

1048708 Abdominal Ultrasound

1048708 Chest X-Ray

1048708 Bone Density Scan

1048708 Labs

1048708 24-hour urine for creatinine clearance

1048708 Cancer Screens




Heart Transplant1048708 1960s

1048708 First heart transplants performed

1048708 1980s

1048708 Anti-rejection meds became available (Cyclosporine)

1048708 Today

1048708 About 80 of heart transplants are alive two years after the operation

1048708 50 percent survive 5 years

























1048708 EKG








1048708 Pulmonary


1048708 CT Chest




1048708 Renal

1048708 Urinalysis




1048708 Stool guiac



1048708 Colonoscopy




1048708 HLA typing







1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety


1048708 Finances





Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs





























1048708 EKG








1048708 Pulmonary


1048708 CT Chest




1048708 Renal

1048708 Urinalysis




1048708 Stool guiac



1048708 Colonoscopy




1048708 HLA typing







1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety


1048708 Finances





Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs







1048708 Pulmonary


1048708 CT Chest




1048708 Renal

1048708 Urinalysis




1048708 Stool guiac



1048708 Colonoscopy




1048708 HLA typing







1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety


1048708 Finances





Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs







1048708 Renal

1048708 Urinalysis




1048708 Stool guiac



1048708 Colonoscopy




1048708 HLA typing







1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety


1048708 Finances





Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs








1048708 HLA typing







1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety


1048708 Finances





Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs







1048708 Compliance

1048708 Support

1048708 Depression

1048708 Anxiety


1048708 Finances





Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs








Program


Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Patient Education









Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Donor Selection









1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs










1048708


40yrs of age





















1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs

























1 - Mild A - Focal










GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






GRADE 1A

GRADE 2

GRADE 1B


GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






GRADE 4

GRADE 3A GRADE 3B

ThresholdMandatory

ForTherapy





IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs









IV steroids













Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs














Transmedics Inc










1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs














1048708 Rejection



1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs







1048708 Denervation


perfusion injury


1048708 Dysrhythmia





1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs







1048708 Prophylaxis

1048708 Viral - CMV


1048708 Fungal


bull Toxoplasmosis

bull TB




1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs








1048708 Hyperacute

1048708 Acute

1048708 Chronic






Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs










Recovery Phase

Hospital Discharge


Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Home Assessment

1048708 Weight


1048708 Heart rate

1048708 Temperature



Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Routine Testing

1048708 Lab work

1048708 Chest X-ray

1048708 EKG












delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs













delayed


catecholamines


completed


prolonged


Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Long Term Follow Up



Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Medical Issues


1048708 Infection

1048708 Rejection


vasculopathy



1048708 Diabetes


1048708 Obesity




tolerance

1048708 Malignancy


1048708 Depression








bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs












bull Travel

bull Adjustment





1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs









1048708 Body Image






1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs







1048708 Insurance

1048708 Employment




Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






Yearly Evaluation


1048708 Echo



1048708 Chest X-Ray


1048708 Labs






critical care of heart transplantation. heart transplant 1960s: first heart transplants performed...

Documents