16. HF part 5: Heart transplantation 101 with Dr. JoAnn Lindenfeld​

Heart transplantation requires precise organ allocation, rigorous donor selection, and meticulous long-term management. The UNOS allocation system recently transitioned to a six-tier structure to prioritize the sickest patients, such as those on ECMO or mechanical circulatory support, though early data on mortality outcomes remains preliminary. Expanding the donor pool relies on innovative strategies, including utilizing Hepatitis C positive hearts, donation after circulatory death (DCD), and ex vivo perfusion technologies. Post-transplant care focuses on mitigating primary graft dysfunction and managing long-term complications like coronary allograft vasculopathy, renal failure, and malignancy. Because immunosuppressive drugs, particularly calcineurin inhibitors, carry significant risks of drug-drug interactions, non-transplant physicians must coordinate closely with transplant centers when prescribing new medications to avoid adverse events like rhabdomyolysis or bone marrow depression. Dr. JoAnn Lindenfeld, Director of the Vanderbilt Heart Failure and Transplant Program, provides these expert insights on the evolving landscape of cardiac transplantation.