Table 2.

Absolute and relative contraindications to heart transplantation. PAS: Pulmonary Artery Systolic Pressure, TPG: Trans Pulmonary Gradient, PVR: Pulmonary Vascular Resistance, HIV: Human Immunodeficiency Virus, BMI: Body Mass Index.

Absolute Contraindications

Age > 70 years

Severe pulmonary hypertension with PAS > 50 mm Hg, TPG > 15 mm Hg, PVR > 3 Wood Units irreversible with milrinone/levosimendan

Severe lung disease (e.g., forced expiratory volume in one second; and forced vital capacity <50% of predicted value) or evidence of parenchymal lung disease)

Multisystem disease with poor long-term survival

Viral infection (hepatitis B, hepatitis C, and HIV) with organ damage and with detectable viral titles

Severe local or systemic infection not caused by left ventricular assist device

Active smokers/substance abuse

History of cancer (multidisciplinary cardio-oncology team evaluation is recommended)

Severe neurological deficit/significant psychiatric illness

Relative contraindications

Diabetes mellitus with end-organ damage (e.g., nephropathy, neuropathy, proliferative retinopathy) or poorly controlled diabetes with glycosylated hemoglobin persistently >7.5% or 58 mmol/mol

Irreversible renal dysfunction with an estimated glomerular filtration rate <40 mL/min/1.73 m2 if the patient is not a candidate for a combined heart-kidney transplant

Irreversible liver dysfunction (e.g., cirrhosis) if the patient is not a candidate for a combined heart-liver transplant.

Severe obesity (BMI > 35 kg/m2)

Psychosocial factors (Inability to make a solid commitment to transplantation, Absence of adequate external psychosocial supports)