Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care

Significant practice-changing developments have occurred in the care of heart transplantation candidates and recipients over the past decade. This Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement provides evidence-based, expert panel recommendations with values and preferences, and practical tips on: (1) patient selection criteria; (2) selected patient populations; and (3) post transplantation surveillance. The recommendations were developed through systematic review of the literature and using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The evolving areas of importance addressed include transplant recipient age, frailty assessment, pulmonary hypertension evaluation, cannabis use, combined heart and other solid organ transplantation, adult congenital heart disease, cardiac amyloidosis, high sensitization, and post-transplantation management of antibodies to human leukocyte antigen, rejection, cardiac allograft vasculopathy, and long-term noncardiac care. Attention is also given to Canadian-specific management strategies including the prioritization of highly sensitized transplant candidates (status 4S) and heart organ allocation algorithms. The focus topics in this position statement highlight the increased complexity of patients who undergo evaluation for heart transplantation as well as improved patient selection, and advances in post-transplantation management and surveillance that have led to better long-term outcomes for heart transplant recipients. Les pratiques relatives aux soins prodigués aux candidats à une transplantation cardiaque et aux receveurs d’un nouveau cœur ont beaucoup évolué depuis dix ans. Le présent énoncé de position conjoint de la Société canadienne de cardiologie et du Canadian Cardiac Transplant Network fait état des recommandations d’un groupe d’experts fondées sur des données probantes, et comprend des valeurs et des préférences ainsi que des conseils pratiques concernant les critères de sélection des patients, des populations de patients particulières et la surveillance post-transplantation. Ces recommandations ont été formulées à la suite d’une revue exhaustive de la littérature et au moyen du système GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Les domaines d’importance en évolution abordés comprennent l’âge du receveur, l’évaluation de sa fragilité, l’évaluation de l’hypertension pulmonaire, l’usage de cannabis,