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- •Introduction
- •Contents
- •Renin-Angiotensin Inhibitors: ACE Inhibitors (ACEi), Angiotensin Receptor Blockers (ARB), and Combined ARB/Neprilysin Inhibitors (ARNi)
- •Beta-Blockers
- •Mineralocorticoid-Receptor Antagonists
- •SGLT2 Inhibitors
- •Editor and Contributors
- •1 Medical Therapy for Patients with End-Stage Heart Failure
- •Abstract
- •Clinical Pearls
- •Introduction
- •Medical Therapy for Heart Failure with Reduced Ejection Fraction HFrEF
- •Diuretics/Fluid Management
- •Hydralazine and Isosorbide Dinitrate
- •Additional Medications
- •Device Management of Advanced Heart Failure
- •Cardiac Resynchronization Therapy
- •Indwelling Pulmonary Artery Pressure Sensors
- •Treatment of the Hospitalized Patient with Acute Decompensation
- •References
- •2 Mechanical and Surgical Options for Patients with End-Stage Heart Failure
- •Abstract
- •Clinical Pearls
- •Introduction
- •Ventricular Assist Device Categories: A Generational History
- •Trends in Ventricular Assist Device Use: Strategies and Outcomes
- •Contraindications to LVAD Insertion
- •Potential Adverse Events with Left Ventricular Assist Devices
- •Left Ventricular Assist Device Selection
- •Short-Term Options for Mechanical Circulatory Support
- •Intra-Aortic Balloon Pump
- •Extracorporeal Membrane Oxygenation
- •Percutaneous Mechanical Circulatory Support
- •Heart Transplantation
- •References
- •3 Evaluation for Heart Transplant Candidacy
- •Abstract
- •Clinical Pearls
- •Introduction
- •Indications for Heart Transplantation
- •The Evaluation
- •Assessment of Heart Failure Severity
- •Models to Predict Survival in Advanced HF Patients
- •Psychosocial Evaluation
- •References
- •4 Potential Contraindications to Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Heart Transplant Contraindications
- •Obesity
- •Malignancy
- •Pulmonary Hypertension
- •Primary Pulmonary Disease
- •Diabetes Mellitus
- •Renal Dysfunction
- •Hepatic Dysfunction
- •Cerebrovascular and Peripheral Vascular Disease
- •Frailty
- •Infections
- •Hepatitis B
- •Hepatitis C
- •Tuberculosis
- •Chagas Disease
- •Substance Use
- •Other Systemic Diseases
- •Psychosocial Evaluation
- •Financial Considerations
- •References
- •5 Listing Criteria and Optimization of the Pre-transplant Patient
- •Abstract
- •Clinical Pearls
- •Listing Process
- •Allocation Criteria
- •A Brief History
- •The 2018 Allocation Revision
- •Optimization of the Pre-transplant Patient
- •Medical Surveillance on the Waitlist
- •Immunological Optimization
- •Other Considerations for Patients on the Waitlist
- •References
- •6 Overview of Transplantation Immunobiology
- •Abstract
- •Clinical Pearls
- •Innate Versus Adaptive Immunity
- •Human Leukocyte Antigens Polymorphism and Nomenclature
- •Overview and Polymorphism of HLA
- •HLA Nomenclature
- •Alloantigen Presentation
- •Antibody Production and Biology
- •Endothelial Cell Activation by Antibodies
- •Tolerance
- •References
- •Methods of Assessment for HLA and Non-HLA Antibodies
- •Panel Reactive Antibodies
- •Virtual Crossmatch
- •Non-HLA Antibodies
- •Calculated PRA (cPRA)
- •Therapeutic Options for the Sensitized Patient
- •Plasmapheresis and Immunoadsorption
- •Intravenous Immune Globulin (IVIg)
- •7 The Sensitized Patient Awaiting Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Risk Factors for Sensitization
- •Clinical Implication of HLA Antibodies
- •Rituximab
- •Proteasome Inhibitors
- •Emerging Desensitization Strategies
- •Splenectomy
- •Eculizumab
- •Monitoring of Sensitized Patients While Awaiting Transplantation
- •Conclusions
- •References
- •8 Donor Organ Procurement and Preservation
- •Abstract
- •Clinical Pearls
- •Donation After Brain Death (DBD)
- •Donation After Circulatory Death (DCD)
- •Donor Referral and Evaluation
- •Donor Acceptability and Recipient Matching
- •DCD Heart Evaluation
- •Donor Heart Procurement
- •Direct Procurement and Machine Perfusion (DP/MP)
- •Normothermic Regional Perfusion (NRP)
- •Donor Heart Preservation
- •Normothermic Machine Perfusion
- •Controlled Temperature Static Storage
- •Hypothermic Machine Perfusion
- •References
- •9 Surgical Considerations in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Surgical Technique of Donor Heart Recovery
- •Biatrial Orthotopic Cardiac Transplantation
- •Indications
- •Technique
- •Bicaval Technique
- •Operative Technique
- •Heterotopic Heart Transplantation
- •Indications
- •Operative Technique
- •Special Considerations
- •References
- •10 Physiology of the Transplanted Heart
- •Abstract
- •Clinical Pearls
- •Introduction
- •The Autonomic Nervous System
- •Functional Anatomy
- •Parasympathetic Fibers
- •Sympathetic Fibers
- •Cardiac Pacemaker
- •Autonomic Physiology
- •Homeostasis of the Cardiovascular System
- •Exercise and the Denervated Heart
- •Allograft Response to Exercise
- •Exercise Protocols for the Heart Transplant Recipient
- •High-Intensity Interval Training
- •Reinnervation
- •Determinants of Reinnervation
- •Quantifying Reinnervation
- •Parasympathetic Reinnervation
- •Electrophysiology of the Transplanted Heart
- •Pharmacology of the Transplanted Heart
- •Beta-Blockers
- •Beta-Adrenergic Receptor Agonists
- •Atropine
- •Adenosine
- •Digoxin
- •References
- •11 Immediate Post-operative Management After Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Recommended Hemodynamic Monitoring
- •Causes of Cardiac Allograft Dysfunction
- •Primary Graft Dysfunction
- •Management of Cardiac Allograft Dysfunction
- •Management of Vasoplegia
- •Hyperacute Rejection
- •Intrathoracic Hemorrhage and Cardiac Tamponade
- •Pulmonary Hypertension
- •Electrical Monitoring
- •Sinus Node Dysfunction
- •Atrial Fibrillation
- •Ventricular Tachycardia
- •Non-cardiac Medical Issues After Heart Transplant
- •Renal Dysfunction
- •Neurological Dysfunction
- •Gastrointestinal Dysfunction
- •Antibiotic Use for Prophylaxis of Infection
- •Debility
- •Conclusions
- •References
- •12 Maintenance Immunosuppression Strategies in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction to Transplant Immunosuppression
- •Immunosuppressive Agents for Maintenance Regimens
- •Corticosteroids
- •Mechanism of Action
- •Calcineurin Inhibitors: Cyclosporine and Tacrolimus
- •Mechanism of Action
- •Notes
- •Drug Interactions
- •Antiproliferative
- •Azathioprine
- •Mechanism of Action
- •Mycophenolate Mofetil (MMF)
- •Mechanism of Action
- •Notes
- •Proliferation Signal Inhibitors (PSIs): Sirolimus and Everolimus
- •Mechanism of Action
- •Notes
- •Drug Interactions
- •Statins
- •Major Clinical Trials of Maintenance Immunosuppression Regimens—Which Agent to Use?
- •Comparison by Survival
- •Comparison by Incidence of Rejection
- •Individualizing Immunosuppression
- •Conclusions
- •References
- •13 Induction Strategies in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Depleting Antibodies
- •Polyclonal Antibodies
- •Monoclonal Antibodies
- •Non-depleting Antibodies
- •Basiliximab
- •Eculizumab
- •References
- •14 Minimization of Immunosuppression in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Sequelae of Immunosuppression
- •Minimization of Immunosuppression Strategies
- •Standard Maintenance Immunosuppression
- •Prednisone Weaning
- •Calcineurin Minimization
- •Use of Proliferation Signal Inhibitors to Reduce or Replace Calcineurin Inhibitors
- •Tacrolimus Monotherapy to Minimize Immunosuppression
- •Personalizing Immunosuppression
- •T Cell Immune Function Assay
- •Future Directions to Minimize Immunosuppression
- •References
- •15 Pre-transplant Screening and Post-transplant Infection Prevention in Heart Transplant Recipients
- •Abstract
- •Clinical Pearls
- •Pre-transplant Screening of the Donor and Recipient
- •Donor Screening
- •Bacterial Transmission
- •Fungal Transmission
- •Viral Transmission
- •Hepatitis B
- •Hepatitis C
- •Cytomegalovirus
- •Human T-Lymphotropic Virus
- •West Nile Virus
- •SARS-CoV2
- •Protozoal Transmission
- •Toxoplasma Gondii, Trypanosoma Cruzi (Chagas Disease)
- •Recipient Screening
- •Bacterial/Fungal/Viral Infections
- •Preventive Measures
- •References
- •16 Managing Infections After Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Bacterial Infections
- •Peri-Operative Prophylaxis
- •Gram-Positive Organisms
- •Staphylococci
- •Enterococci
- •Streptococcus Pneumoniae
- •Listeria Monocytogenes
- •Nocardia
- •Rhodococcus Equi
- •Mycobacteria
- •Gram-Negative Organisms
- •Aerobic Gram-Negative Bacilli
- •Legionella
- •Clostridium Difficile
- •Viral Infections
- •Peri-Operative Prophylaxis
- •Cytomegalovirus
- •Herpes Simplex Virus
- •Varicella Zoster Virus
- •Epstein Barr Virus
- •Community Respiratory Viruses
- •Hepatitis B
- •Hepatitis C
- •Other Viruses
- •Fungal Infections
- •Peri-Operative Prophylaxis
- •Candida Spp.
- •Aspergillus
- •Pneumocystis Jiroveci
- •Opportunistic Molds and Yeasts
- •Protozoa
- •Toxoplasma Gondii
- •Trypanosoma Cruzi
- •Clinical Approach to Infectious Features
- •Fever
- •Wound Infections
- •Urinary Tract Infections
- •CNS Infection
- •GI and Liver Infections
- •References
- •17 COVID-19 Considerations in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •COVID-19 in Heart Transplant Recipients
- •Management of COVID-19-Positive Heart Transplant Patients
- •Adjusting Chronic Immunosuppressive Therapies
- •Pharmacologic Therapies
- •Ritonavir-Boosted Nirmatrelvir (Paxlovid)
- •Remdesivir
- •Molnupiravir
- •COVID-19 Convalescent Plasma
- •Corticosteroids
- •Interleukin-6 Inhibitors and Janus Kinase Inhibitors
- •COVID-19 Vaccination Immune Paresis in Heart Transplant Recipients
- •Correlates of Protection
- •Waning Immunity and Variant Evolution
- •Strategies to Mitigate COVID-19 Vaccine Immune Paresis in Heart Transplant Recipients
- •References
- •18 Cardiac Allograft Rejection Surveillance
- •Abstract
- •Clinical Pearls
- •Introduction
- •Pathology and Diagnosis of Cardiac Allograft Rejection
- •The Endomyocardial Biopsy (EMB)
- •Procedural Technique
- •Procedural Limitations
- •Potential Complications
- •Scheduling of EMB
- •Histological Features of Allograft Rejection
- •Intragraft mRNA Transcript Diagnostics to Augment the EMB
- •Non-invasive Diagnostic Methods in Cardiac Allograft Rejection
- •Clinical Evaluation and Antibody Surveillance
- •Donor-Derived Cell-Free DNA
- •Electrocardiogram (ECG)
- •Echocardiography
- •Cardiac Magnetic Resonance Imaging (CMRI)
- •Biomarkers
- •Future Directions
- •References
- •19 Cardiac Allograft Rejection Treatment
- •Abstract
- •Clinical Pearls
- •Introduction
- •Acute Cellular Rejection (ACR)
- •Risk Factors for ACR
- •Treatment of ACR
- •Recurrent Cellular Rejection
- •Hyperacute Rejection
- •Antibody-Mediated Rejection (AMR)
- •Risk Factors for AMR
- •Treatment of AMR
- •Biopsy Negative Rejection
- •Late Acute Rejection
- •Future Directions
- •References
- •20 Medical Adherence and Outcomes After Heart Transplant
- •Abstract
- •Clinical Pearls
- •Introduction
- •Metrics of Compliance and Associated Challenges
- •Adherence and Heart Transplant Outcomes
- •Factors Associated with Poor Medical Adherence
- •Compliance with Lifestyle Habits
- •Interventional Strategies to Improve Adherence in Heart Transplant Recipients
- •Future Directions
- •References
- •21 Cardiac Allograft Vasculopathy
- •Abstract
- •Clinical Pearls
- •Epidemiology
- •Pathophysiology
- •Clinical Features
- •Diagnosis
- •Invasive Assessment of Cardiac Allograft Vasculopathy
- •Non-invasive Assessment of Cardiac Allograft Vasculopathy
- •Management
- •Medical
- •Interventional
- •References
- •22 Long-Term Complications in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Outpatient Management
- •Malignancy
- •General Medical Management
- •Cardiovascular Risk Factors
- •Renovascular
- •Endocrine
- •Gastrointestinal
- •References
- •23 Pediatric Cardiomyopathies
- •Abstract
- •Clinical Pearls
- •Dilated Cardiomyopathy
- •Hypertrophic Cardiomyopathy
- •Restrictive Cardiomyopathy
- •Oncological Cardiomyopathy
- •References
- •24 Pediatric Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Indications for Heart Transplantation
- •Candidate Evaluation
- •Anatomy
- •Pulmonary Vascular Resistance
- •ABO Incompatibility
- •Pre-transplant Sensitization
- •Infection
- •Other Organ Systems
- •Psychosocial Factors
- •Donor Selection
- •Wait List Management
- •Bridge to Transplant
- •Post-operative Management and Complications
- •Cardiovascular System
- •Respiratory System
- •Renal Function
- •Gastrointestinal System
- •Immunosuppression
- •Infection
- •Rejection Surveillance
- •Rejection
- •Long-Term Complications
- •Cardiac Allograft Vasculopathy
- •Infection and Malignancy
- •Survival and Outcomes
- •Equity
- •Summary
- •References
- •25 Adult Congenital Heart Disease—Special Considerations
- •Abstract
- •Clinical Pearls
- •Introduction
- •Challenges in Identifying Advancing ACHD-HF
- •Evaluation of the ACHD Patient Referred for Transplant Listing
- •Indications for Referral and Evaluation
- •Multi-disciplinary Evaluation
- •Role of the ACHD Cardiologist
- •HF Pharmacotherapy
- •Special Considerations for the ACHD Patient
- •Pre-transplant Hemodynamic and Vascular Assessment
- •Transplant Surgical Evaluation
- •Pulmonary Hypertension
- •Cyanosis
- •Sensitization
- •Liver Disease
- •Management of ACHD Patient Listed for Transplant
- •Mechanical Circulatory Support
- •ACHD Transplant Outcomes
- •References
- •26 Combined Heart and Other Organ Transplants
- •Abstract
- •Clinical Pearls
- •Introduction
- •The Ethics of Dual Organ Transplantation: Evaluating Fairness in Organ Allocation
- •Heart-Kidney Transplantation
- •The Pathophysiology of Cardiorenal Disease Leading to End Organ Failure
- •Safety Net
- •Outcomes of Heart-Kidney Transplantation
- •Management of the sHKT Patient
- •Heart-Liver Transplantation
- •Concerns for CHD Patients, Particularly the Fontan Population Who Require CHLT
- •Criteria to Proceed with CHLT
- •Surgical Approach and CHLT for Highly Sensitized Patients
- •Recommendations for Post-CHLT Management
- •Heart–Lung Transplantation
- •Indications for Heart–Lung Transplantation
- •Recipient and Donor Considerations for Heart–Lung Transplant
- •Management and Complications of Heart Lung Transplant Recipients:
- •Survival After Heart–Lung Transplantation
- •References
- •27 Pregnancy in Heart Transplant Recipients
- •Abstract
- •Clinical Pearls
- •Introduction
- •Preconception Counseling
- •Contraception
- •Assisted Reproductive Technology (ART)
- •Shared Decision-Making
- •Fatherhood After Transplantation
- •Risk Assessment, Management, and Outcomes of Pregnancy After Heart Transplantation
- •Timing of Pregnancy
- •Patient Risk Assessment
- •Surveillance
- •Baseline Evaluation of Graft Function and Risk Assessment
- •Surveillance of Rejection
- •Diagnosis and Treatment of Acute Rejection
- •Maternal and Fetal Outcomes
- •Maternal Outcomes
- •Fetal Outcomes
- •Management of Comorbid Conditions During Pregnancy
- •Diabetes
- •Hypertension
- •Infections
- •Immunosuppression During Pregnancy
- •Postpartum Management
- •References
- •Abstract
- •Clinical Pearls
- •Introduction
- •Historical Perspectives
- •Abiomed AbioCor TAH
- •Carmat Aeson TAH
- •BiVACOR TAH
- •Perioperative Management
- •Clinical TAH Outcomes
- •Summary and Future Directions
- •References
- •29 Xenotransplantation
- •Abstract
- •Clinical Pearls
- •History of Xenotransplantation
- •Xenograft Rejection
- •Hyperacute Rejection
- •Complement Activation
- •Acute Humoral Rejection
- •Acute Cellular Rejection
- •Graft Overgrowth
- •Infections
- •Ethical Considerations
- •References
- •30 Quality-of-Life After Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Introduction
- •Aspects of Quality-of-Life
- •Assessing Quality-of-Life
- •Physical Wellbeing
- •Functional Status
- •Employment
- •Operating Vehicles
- •Mental Health
- •Social Functioning
- •Reproductive Health
- •References
- •31 Patient Selection in the Context of Organ Scarcity
- •Abstract
- •Clinical Pearls
- •Introduction
- •Ethical Principles
- •Optimizing Donor and Recipient Risk Matching
- •Psychosocial Considerations
- •Financial Considerations
- •Balancing Individual and Societal Interests
- •References
- •32 Diversity and Access in Heart Transplantation
- •Abstract
- •Clinical Pearls
- •Map of Racial Disparities in Heart Failure Prevalence and Access to Advanced Therapies
- •Insurance Status and Access to Transplantation
- •Socioeconomic Stressors and Heart Transplant-Related Outcomes
- •The New Allocation System and Its Impact on Improved Access to Transplantation for Racial Minorities
- •Gender Disparities
- •Future Directions
- •References

Clinical Guide
toHeart
Transplantation
JonKobashigawa
Editor
SecondEdition
123

Clinical Guide to Heart Transplantation

Jon Kobashigawa
Editor
Clinical Guide to Heart
Transplantation
Second Edition

Editor
Jon Kobashigawa
DSL/Thomas D. Gordon Professor
of Medicine
Director, Advanced Heart Disease
Division
Director, Heart Transplant Program
Associate Director, Smidt Heart Institute
Associate Director, Comprehensive
Transplant Center
Cedars-Sinai Medical Center,
Los Angeles, CA, USA
ISBN 978-3-031-88289-0 ISBN 978-3-031-88290-6 (eBook)
https://doi.org/10.1007/978-3-031-88290-6
1st edition: © Springer International Publishing AG 2017
2nd edition: © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher
nor the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.

This edition of Clinical Guide to Heart
Transplantation is dedicated to the
memory of our dear colleague and
co-author, Jignesh Patel M.D. Ph.D.

Introduction
In the 8 years since the first edition of this Clinical Guide to Heart
Transplantation was published, the field of cardiac transplantation has
evolved significantly. Innovations in donor procurement and preservation are being deployed, including the use of donors who suffer circulatory death, expanding the availability of hearts for patients who need them.
New biomarkers and diagnostic tools are being leveraged to better assess
risk and to calibrate monitoring and early intervention. New concepts in
immunotherapy are being explored as we get closer to the goal of personalized medicine. The technology for both artificial and bio-engineered hearts
is advancing at a previously unimagined pace and xenotransplantation as a
viable therapeutic option is now within our reach. Machine learning is being
used to power diagnostics, including the use of big data to improve pathology assessments by leveraging information at the molecular level. The
advent of virtual visits, virtual crossmatching, and virtual reality have propelled our field into a new era. Indeed, transplantation medicine remains a
fertile frontier for translational research.
This 2nd Edition incorporates emerging science in the field and provides
updates on evidence-based management strategies for patients both pre- and
post-heart transplantation. This includes the unexpected and hard-earned
knowledge of how to manage immunocompromised patients during a pandemic, the management of sensitized patients awaiting heart transplantation,
and the complexities of patients who require dual-organ transplantation.
Though the science, medicine, and practice of heart transplantation has
entered a new and exciting phase, the art of heart transplantation remains
the same. The art of caring for a patient, of listening to their story, of understanding their goals and their fears, of shaping a course of treatment with
them rather than for them, remains the hallmark of good medicine. “What
is the right thing for this patient?” This is still the question that drives our
work, even as we strive to break new ground and cross old barriers.
As practitioners in this field, we are charged with making critical determinations in the management of patients, donor organs, and the transplant
process itself in order to achieve the greatest benefit in the utilization of a
scarce resource, including the hard task of addressing equity and access.
This handbook is designed to be a reference for those on the front lines.
While this compilation of best practices cannot address the complexity of
vii

viii Introduction
the individual patients we care for on a daily basis, it is my hope that it will
serve to help us ask the right questions, access the best evidence, and ultimately make the best decisions for the patients we are privileged to serve.
Los Angeles, USA
October 2024
Jon Kobashigawa M.D.

Contents
Part I Advanced Heart Failure Treatments
1 Medical Therapy for Patients with End-Stage
Heart Failure ......................................... 3
Michele Hamilton and Yosef Manla
2 Mechanical and Surgical Options for Patients with End-
Stage Heart Failure .................................... 15
Robert M. Cole, Jaime D. Moriguchi, and Yosef Manla
3 Evaluation for Heart Transplant Candidacy ............... 27
Michele Hamilton and Yosef Manla
4 Potential Contraindications to Heart Transplantation ....... 33
Michelle M. Kittleson
Part II Pre-Heart Transplant Considerations
5 Listing Criteria and Optimization of the Pre-transplant
Patient ............................................... 53
Michelle M. Kittleson
6 Overview of Transplantation Immunobiology .............. 61
Xiaohai Zhang
7 The Sensitized Patient Awaiting Heart Transplantation ...... 75
Jignesh Patel and Krishan Patel
8 Donor Organ Procurement and Preservation ............... 93
Pedro Catarino
9 Surgical Considerations in Heart Transplantation .......... 101
Fardad Esmailian and Andrew Lin
Part III Post-Heart Transplant Patient Management
10 Physiology of the Transplanted Heart ..................... 111
Andriana P. Nikolova
ix

x Contents
11 Immediate Post-operative Management After Heart
Transplantation ....................................... 127
Evan Kransdorf, Lily Stern, and Yosef Manla
12 Maintenance Immunosuppression Strategies
in Heart Transplantation ............................... 139
Jignesh Patel and Krishan Patel
13 Induction Strategies in Heart Transplantation .............. 163
Lily Stern, Evan Kransdorf, and Yosef Manla
14 Minimization of Immunosuppression in Heart
Transplantation ....................................... 171
David H. Chang and Yosef Manla
15 Pre-transplant Screening and Post-transplant Infection
Prevention in Heart Transplant Recipients ................. 181
Jillian Oft and Phillip Zakowski
16 Managing Infections After Heart Transplantation .......... 189
Jillian Oft and Phillip Zakowski
17 COVID-19 Considerations in Heart Transplantation ........ 207
Yael Peled
18 Cardiac Allograft Rejection Surveillance .................. 227
David H. Chang and Yosef Manla
19 Cardiac Allograft Rejection Treatment .................... 237
David H. Chang and Yosef Manla
Part IV Long-Term Management of Heart Transplant
Recipients
20 Medical Adherence and Outcomes After Heart
Transplant ........................................... 253
Andriana P. Nikolova
21 Cardiac Allograft Vasculopathy .......................... 259
Lily Stern, Evan Kransdorf, and Yosef Manla
22 Long-Term Complications in Heart Transplantation ........ 271
Lily Stern, Evan Kransdorf, and Yosef Manla
Part V Special Considerations
23 Pediatric Cardiomyopathies ............................. 279
Juan C. Alejos and Majid Husain
24 Pediatric Heart Transplantation ......................... 287
Juan C. Alejos and Majid Husain
25 Adult Congenital Heart Disease—Special Considerations .... 309
Rose Tompkins

26 Combined Heart and Other Organ Transplants ............ 327
Jon Kobashigawa and Yosef Manla
27 Pregnancy in Heart Transplant Recipients ................. 341
Michelle M. Kittleson
Part VI The Future of Heart Transplantation
28 The Total Artificial Heart ............................... 365
Jaime D. Moriguchi
29 Xenotransplantation ................................... 377
Emily Newman, Indranee Rajapreyar, Yevgeniy Brailovsky,
and Howard J. Eisen
Part VII Ethical Considerations In Heart Transplantation
30 Quality-of-Life After Heart Transplantation ............... 387
Jignesh Patel and Michelle M. Kittleson
31 Patient Selection in the Context of Organ Scarcity .......... 395
Jignesh Patel and Yael Peled
32 Diversity and Access in Heart Transplantation ............. 401
Andriana P. Nikolova
xiContents
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