2010 ISHLT Guidelines for the Care of Heart Transplant Recipients

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Published 1 August 2010

Maria Rosa Costanzo, MD; Anne Dipchand, MD; Randall Starling, MD; Allen Anderson, MD; Michael Chan, MD; Shashank Desai, MD; Savitri Fedson, MD; Patrick Fisher, MD; Gonzalo Gonzales-Stawinski, MD; Luigi Martinelli, MD; David McGiffin, MD; Francesco Parisi, MD; Jon Smith, MD; David Taylor, MD; Bruno Meiser, MD; Steven Webber, MD; David Baran, MD; Michael Carboni, MD; Thomas Dengler, MD; David Feldman, MD; Maria Frigerio, MD; Abdallah Kfoury, MD; Daniel Kim, MD; Jon Kobashigawa, MD; Michael Shullo, PharmD; Josef Stehlik, MD; Jeffrey Teuteberg, MD; Patricia Uber, PharmD; Andreas Zuckermann, MD; Sharon Hunt, MD; Michael Burch; Geetha Bhat, MD; Charles Canter, MD; Richard Chinnock, MD; Marisa Crespo-Leiro, MD; Reynolds Delgado, MD; Fabienne Dobbels, PhD; Kathleen Grady, PhD; Kao W, MD; Jaqueline Lamour, MD; Gareth Parry, MD; Jignesh Patel, MD; Daniela Pini, MD; Sean Pinney, MD; Jeffrey Towbin, MD; Gene Wolfel, MD; Diego Delgado, MD; Howard Eisen, MD; Lee Goldberg, MD; Jeff Hosenpud, MD; Maryl Johnson, MD; Anne Keogh, MD; Clive Lewis, MD; John O'Connell, MD; Joseph Rogers, MD; Heather Ross, MD; Stuart Russell, MD; Johan Vanhaecke, MD

J Heart Lung Transplant. 2010 Aug;29(8):914-56

  • Advanced Heart Failure & Transplantation
  • Anesthesiology & Critical Care
  • Cardiology
  • Cardiothoracic Surgery
  • Infectious Diseases
  • Nursing & Allied Health
  • Pediatrics
  • Pharmacy
  • Professional Guideline
  • Publications & Journals
  • Research & Immunology
  • Standards & Guidelines

Since the dawn of heart transplantation in the 1960s, the medical care of heart transplant recipients has been guided by the experience of individual clinicians and has varied from center to center. Despite many advances in surgical techniques, diagnostic approaches, and immunosuppressive strategies, survival after heart transplantation is limited by the development of cardiac allograft vasculopathy and by the adverse effects of immunosuppression. The International Society for Heart and Lung Transplantation (ISHLT) has made an unprecedented commitment to convene experts in all areas of heart transplantation to develop practice guidelines for the care of heart transplant recipients.

The document results from the work of 40 writers from 9 countries worldwide split into 3 Task Force groups:

  • Task Force 1 addresses the peri-operative care of heart transplant recipients, including the surgical issues affecting early post-operative care; monitoring and treatment of early hemodynamic, metabolic, and infectious issues; evaluation and treatment of allosensitization; evaluation and treatment of early coagulopathies; the organization of a multidisciplinary care team; management of ABO “incompatible” pediatric heart transplantation; and the use of extracorporeal membrane oxygenation (ECMO) for the hemodynamic support of pediatric recipients.
  • Task Force 2 discusses the mechanisms, diagnosis, and treatment of heart transplant rejection; the mechanisms of action, dosing, and drug level monitoring of immunosuppressive drugs as well as their adverse effects and interactions with concomitantly used medications; and reviews the major clinical trials and the immunosuppressive strategies to be used in special clinical situations.
  • Task Force 3 covers the myriad of clinical issues occurring long-term after heart transplantation, including cardiac allograft vasculopathy, the chronic adverse effects of immunosuppression (neurotoxicity, renal insufficiency, hypertension, bone disease, diabetes and malignancy), as well as reproductive health, exercise, psychologic problems, return to work, and operation of motor vehicles after heart transplantation.

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An update to this guideline has been developed and was published in 2022.

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