TN 5 (07-11)
DI 23022.555 Heart Transplant Graft Failure
COMPASSIONATE ALLOWANCE INFORMATION
HEART TRANSPLANT GRAFT FAILURE
Graft Rejection; Tissue Rejection; Organ Rejection; Primary Graft Dysfunction; Cardiac Allograft Vasculopathy
Heart Transplant Graft Failure occurs when a heart transplant recipient’s immune system identifies the transplanted organ (donor heart) as foreign material within the body and attempts to destroy it (rejection). Individuals who receive a heart transplant are monitored closely for signs of organ rejection.
A cardiologist will monitor the heart transplant recipient for signs of rejection. Rejection is one of the leading causes of death in the first year after the organ transplant. Rejection can occur within days of transplantation. Primary graft dysfunction is the most frequent cause of death in the first month after transplant. Chronic rejection occurs months to years after transplantation. When the person is experiencing chronic rejection, the rate of rejection is slow and progressive, with a gradual loss of heart function, eventually leading to heart failure and consideration for a re-transplant.
Failure of the donor heart can also occur if cardiac allograft vasculopathy (CAV) develops. CAV is a chronic (on-going) disease in which the walls of the coronary arteries in the new heart becomes thick, hard, and lose their elasticity. CAV can impair blood circulation in the new heart and cause serious damage. CAV is a leading cause of donor heart failure and death in the years following transplant surgery. CAV may contribute to heart attack, heart failure, dangerous changes in heart rhythm (arrhythmias) and sudden cardiac arrest.
Immunosuppressive drugs are prescribed to prevent organ rejection. If these drugs are not given, the transplanted heart would induce an immune response in the recipient’s body resulting in loss of heart function. Symptoms of transplant failure include heart failure with generalized edema (swelling), general discomfort or ill feeling, pain or swelling in the location of the organ and fever.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing used in the identification of organ failure such as magnetic resonance imaging identifies physical changes in the structure of the heart and measures systolic and diastolic function. The evaluation of myocardial dysfunction is used to detect heart transplant rejection.
ONSET AND PROGRESSION
The onset and progression of heart transplant graft failure are variable and dependent on the clinical condition of the donor. It can begin within days of transplantation to months or years after the donor heart has been received.
Cardiac graft rejection is an important factor limiting the long-term survival after heart transplantation. Because the signs and symptoms are generally silent- and not immediately noticed by the heart transplant recipient, regular follow-up with a cardiologist promotes the timely detection of complications resulting from heart transplantation. The goal of treatment is to ensure that the transplanted heart is functioning properly and to suppress the recipient’s immune system response. Immunosuppressive drugs are prescribed to stop rejection. These drugs must be taken for the rest of the person’s life.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
Clinical description of findings, cardiology consultation reports, imaging studies of the heart, and blood laboratory testing
Suggested Listings for Evaluation:
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.