Inpatient and Outpatient Preoperative Optimization and Waitlist Management

This chapter focuses on modifiable recipient risk factors that would allow suitable organ acceptance and optimized transplant outcomes. An often understated but important factor in any discussion of waitlist management is the interplay between heart allocation schemes and clinical care of the advanced heart failure patient. In addition to maintaining candidacy, optimization of the recipient is closely linked to the ultimate goal of identifying a suitable donor-recipient match. From a practical perspective, successful donor-recipient matching involves assessment of body and heart size, blood type, predicted ischemic time, and compatibility of antihuman leukocyte antigen antibodies. The use of left ventricular assist device therapy as a bridge to transplant or bridge to candidacy provides an opportunity to further optimize the heart transplantation recipient in the ambulatory setting. Diabetes mellitus and specifically poorly controlled diabetes with end-organ damage in the recipient is an important modifiable risk factor for transplant mortality and primary graft dysfunction.