Table 2.
Required services/specialties for Fontan heart and liver transplantation
| Team/Specialty | Considerations/Perspectives |
|---|---|
| Adult congenital heart disease cardiology | Congenital diagnosis, prior surgeries, anatomy and physiology |
| Congenital interventional cardiology | Invasive hemodynamic assessment, intervention to address residual venous or arterial stenosis, coil embolization collateral vessels to decrease bleeding during transplant |
| Congenital electrophysiology | Ablations, arrhythmia and device management |
| Congenital Radiology/Interventional Radiology (IR) | Provide detailed anatomic assessments and IR to obtain liver biopsies |
| Congenital/transplant cardiac surgery | Assess surgical risk and technical feasibility of heart or combined organ transplant |
| Cardiomyopathy/transplant cardiology | Heart failure optimization, MCS options, management of post-operative immunosuppression and surveillance for rejection |
| Transplant psychiatry | Screen/treat depression and anxiety |
| Transplant social worker | Assess social support and compliance |
| Transplant Financial | Assess insurance compatibility and recommend and coordinate necessary changes. |
| Transplant infectious disease | Management and prevention of opportunistic infections |
| Heart Transplant Nursing Coordination | Primary coordinator of complex evaluation with all team members from point of referral to transplant, patient education. |
| Immunogenetics | Evaluate patient antibody profiles |
| Pulmonology | Evaluate pulmonary function pre-transplant |
| Nephrology | Evaluate need for concurrent renal transplant; management of CKD, and perioperative dialysis for volume management |
| Hematology/Oncology | Evaluate chronic leukopenia and thrombocytopenia, rule out occult malignancy. |
| GI/Hepatology | Evaluate whether patient requires concurrent liver transplant, assessment of varcies |
| Liver transplant surgery | Evaluate suitability for concurrent liver transplant |
| Liver Transplant Nursing Coordination | Coordinate liver evaluation, patient education. |
| Cardiac and Liver Transplant Anesthesiology | Preoperative anesthesia evaluation, identifying modifiable risks an make detailed plan for perioperative anesthesia plan |
| Blood Bank | Prepare for massive transfusions |