Cardiovascular Disease: Heart Failure/NIC

Heart Transplant

Most heart transplants patients will be unable to perform the essential job functions of a LEO due to their risk of sudden cardiac death, rejection, and inability to increase their heart rate due the lack of sympathetic nerve stimulation. However, a few heart transplant patients may be able to perform the essential job functions of a LEO. Therefore, an individualized assessment of the LEO who has undergone a heart transplant is needed to ensure safe and effective job performance.

LEOs having undergone a heart transplant should be restricted for 1-year post transplant surgery and can return to full duty when all the following criteria are met on an annual basis:

• normal 24-hour Holter ECG;
• normal graft function (normal LVEF) by echocardiogram;
• imaging EST to at least 12 METs (see EST in Coronary Artery Disease section);
• no implantable cardioverter defibrillator;
• if a pacemaker placed, not pacemaker dependent;
• evaluate for co-morbidities (e.g., diabetes mellitus, renal failure, cognitive impairment, etc.). If found, refer to the appropriate section of this LEO document;
• stable regimen of cardiovascular medications for the past month;
• no disqualifying side effects from medications (see LEO Medications chapter);
• under the ongoing care (at least annually) by a transplant cardiologist or cardiac transplant surgeon.

If vasculopathy or rejection is found by angiogram or endocardial biopsy, the LEO should be restricted until the issue is resolved. The LEO would still need to meet the bulleted criteria above.