Institutional policy initiative

Select an institutional policy in your practice setting affecting patients, services, or staff to identify and discuss the following issues:
• the policy initiative and its stakeholders
• perceived outcome(s) resulting from the selected initiative and how it addresses the health care issue.
• pros and cons to the initiative and how these impact stakeholders

To describe the immunosuppression therapy protocols for adult heart transplant recipients in an effort to
reduce the risk of acute allograft rejection post-transplant. The following protocols may be used based
upon the recipient’s needs, and risk assessment which will be identified pre-transplant.
Immunosuppression regimens will be tailored to the individual patient.
II. Definitions
Acute Cellular Rejection: is the most common form of rejection and occurs at least once in
approximately 50% of heart transplant recipients.
Hyperacute Rejection: is a result of preformed donor-specific antibodies in the recipient. It is a vigorous
immune response that takes place within minutes to hours. The outcome, without re-transplantation or
total artificial heart support, is uniformly fatal.
Rejection: occurs when transplanted tissue is rejected by the recipient’s immune system, which destroys
the transplanted tissue.
Vascular Rejection: may manifest by otherwise unexplained cardiac allograft dysfunction, with or
without histologic evidence. Histologic evidence is a scant cellular infiltrate but abundant co-localized
immunoglobulin and complement components in the allograft microvasculature seen on one or more
biopsy specimens In addition, vascular rejection may manifest only histologically in the absence of
allograft dysfunction. Vascular rejection is more difficult to treat than acute cellular rejection and is more
often accompanied by hemodynamic compromise or instability. As a result, vascular rejection is
associated with a worse prognosis and appears to increase the risk of cardiac allograft vasculopathy
(CAV) almost tenfold.