Heart Transplantation

Heart transplantation is the definitive treatment for patients with end-stage heart failure who remain severely symptomatic despite optimal medical and device therapy. At SilverOak Health, cardiac transplantation is performed by a multidisciplinary team of cardiothoracic surgeons, transplant cardiologists, anaesthetists, perfusionists, and specialist transplant nurses operating within a formally accredited transplant programme.

Candidate selection is rigorous, involving comprehensive physiological assessment including right heart catheterisation, cardiopulmonary exercise testing, and multi-organ function evaluation to confirm that transplantation represents the best therapeutic option and that the patient has no contraindications. Psychological and social assessments ensure the candidate has the insight and support structure required for life-long immunosuppression adherence.

Once listed, patients are monitored regularly and may require a ventricular assist device (VAD) as a bridge to transplantation to maintain haemodynamic stability while awaiting a suitable donor organ. Donor heart procurement and implantation are performed with established cold ischaemia time protocols to maximise graft function. Primary graft dysfunction — the most serious early complication — is managed with temporary mechanical circulatory support.

Post-transplant immunosuppression, typically combining a calcineurin inhibitor, mycophenolate mofetil, and corticosteroids, is carefully titrated to prevent rejection while minimising infection risk. Endomyocardial biopsy at scheduled intervals detects subclinical rejection early, enabling prompt augmentation of immunosuppression before haemodynamic compromise occurs.

Long-term follow-up includes surveillance for cardiac allograft vasculopathy — the principal cause of late graft failure — through annual coronary angiography or CT coronary imaging. Renal function monitoring, infection screening, malignancy surveillance, and management of transplant-related metabolic complications are integral components of life-long post-transplant care.