The Registry of the International Society for Heart and Lung Transplantation: Twenty-seventh official adult heart transplant report-2010
Available from: Glen J Pearson
- "It is the most common cause of mortality in first year post-transplant, with an incidence of up to 50%, and accounts for ~20% of transplant recipient mortality -. CAV is the most common reason for re-transplantation . CAV has a diffuse pattern of concentric intimal proliferation and luminal stenosis with a progression to total occlusion of the smaller, distal portions of the coronary arteries -. "
- "By 10 years after cardiac transplantation, surviving recipients have hypertension (97%), severe renal insufficiency (14%), hyperlipidemia (93%), diabetes (39%) and angiographic coronary artery vasculopathy (CAV) (52%). Rejection presents with a decreasing functional capacity, malaise and fever. "
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ABSTRACT: An increasing number of cardiac transplants are being carried out around the world. With increasing longevity, these patients present a unique challenge to non-transplant anesthesiologists for a variety of transplant related or incidental surgeries. The general considerations related to a cardiac transplant recipient are the physiological and pharmacological problems of allograft denervation, the side-effects of immunosuppression, the risk of infection and the potential for rejection. A thorough understanding of the physiology of a denervated heart, need for direct vasoactive agents and post-transplant morbidities is essential in anesthetic management of such a patient. Here, we describe a case of a heart transplant recipient who presented for a cholecystectomy at our center.
Available from: Matthew Rafiei
- "Heart transplantation continues to provide patients with end-stage heart disease with extended survival with a half-life of 9.3 years between 2000 and June 2008. . However, despite substantial advancements in immunosuppression, patients continue to be at significant risk for allograft rejection early after cardiac transplantation. "
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The most recent International Society for Heart and Lung Transplantation (ISHLT) biopsy scale classifies cellular and antibody-mediated rejections. However, there are cases with acute decline in left ventricular ejection fraction (LVEF ≤ 45%) but no evidence of rejection on biopsy. Characteristics and treatment response of this biopsy negative rejection (BNR) have yet to be elucidated.
Between 2002 and 2012, we found 12 cases of BNR in 11 heart transplant patients as previously defined. One of the 11 patients was treated a second time for BNR. Characteristics and response to treatment were noted.
12 cases (of 11 patients) were reviewed and 11 occurred during the first year after transplant. 8 cases without heart failure symptoms were treated with an oral corticosteroids bolus and taper or intravenous immunoglobulin. Four cases with heart failure symptoms were treated with thymoglobulin, intravenous immunoglobulin, and intravenous methylprednisolone followed by an oral corticosteroids bolus and taper. Overall, 7 cases resulted in return to normal left ventricular function within a mean of 14 ± 10 days from the initial biopsy.
BNR includes cardiac dysfunction and can be a severe form of rejection. Characteristics of these cases of rejection are described with most cases responding to appropriate therapy.
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