scholarly journals Essentials in the diagnosis of postoperative myocardial lesions similar to or unrelated to rejection in heart transplant

2021 ◽  
Vol 29 (3) ◽  
pp. 307-318
Author(s):  
Costel Dumitru ◽  
Ancuta Zazgyva ◽  
Adriana Habor ◽  
Ovidiu Cotoi ◽  
Horațiu Suciu ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Immunosuppressive Treatment ◽  
Great Influence ◽  
Histological Diagnosis ◽  
Cardiac Transplant ◽  
Ischemia And Reperfusion ◽  
Biopsy Material ◽  
Post Transplant ◽  
Cytomegalovirus Reactivation ◽  
Myocardial Lesions

Abstract Background, objectives: Histological diagnosis of control biopsies in patients with heart transplant represents a significant step of monitoring, with a great influence on adjusting immunosuppressive treatment. Histological lesions are usually related to ischemia and reperfusion, with varying degrees of intensity. This study aimed to highlight the most important aspects of the histological diagnosis and differential diagnosis of postoperative myocardial lesions associated or unrelated to rejection in heart transplant. Materials and Methods: This retrospective study involved 53 patients who received cardiac transplant between 2000 and 2017. Patients were monitored by lesion quantification of endomyocardial biopsies, with diagnoses established based on biopsy material in the early, medium and late post-transplant periods. Hematoxylin eosin, Masson’s trichrome, and Van Gieson stains were used; immunohistochemical determinations used CD4, CD20, CD45, CD68, HLA-DR, VEGF and CD31. Results: Ischemia and reperfusion lesions were diagnosed on all biopsies in the first 6 weeks post-transplant. Nine cases of the Quilty effect were identified, and in 12 cases, the biopsies were performed on the same spot as previous biopsies. A significant number of transplanted patients presented cytomegalovirus that was difficult to diagnose on endomyocardial biopsies. Conclusions: The detailed study of ischemia and reperfusion lesions, as well as of changes un-related to rejection becomes a major objective in the short, medium and late post-transplant period. Overdiagnosis of rejection induces changes of the immunosuppressive therapeutic protocol, with alarming repercussions on cytomegalovirus reactivation, and risks of potentiating inflammation, myocyte destruction and the recurrence of disorders related to both inducing and aggravating heart failure.

scholarly journals Therapeutic Management of Trauma-related Acute Pancreatitis in a Heart Transplant Recipient

2019 ◽  
Vol 70 (9) ◽  
pp. 3100-3102
Author(s):  
Cosmin Banceu ◽  
Simona Gurzu ◽  
Marius Harpa ◽  
Klara Brinzaniuc ◽  
Mihaela Ispas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Heart Transplant ◽  
Immunosuppressive Treatment ◽  
Heart Transplant Recipient ◽  
Cardiac Transplant ◽  
Life And Death ◽  
Disease Mortality ◽  
The Difference

Acute pancreatitis is a very mortal disease, mortality that increases even more in patients with cardiac transplantation. Medical-surgical management of acute pancreatitis in transplanted patients can make the difference between life and death. The aim of this paper was to highlight the severity of this pathology especially because the patient is immunosuppressed after cardiac transplant. A case of 36-year-old man, known with heart transplant, immunosuppressive treatment and chronic renal frailer, who arrived to Emergency Department, with severe abdominal pain and abdominal distention which started after a traumatic accident. Investigations revealed acute pancreatitis that needed three surgeries for acute necrotic hemorrhagic pancreatitis, acute bleeding, left subphrenic abscess and intensive care therapy. With favorable postoperative evolution, patient is discharged 60 days later He�s follow up reveled no gastrointestinal or cardiac complication with an improved quality of life.

Successful Treatment af a Hairy Cell Leukemia (HCL) with Pentostatin in a Cardiac Transplant Recipient.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4815-4815
Author(s):  
Alina Zamfir ◽  
Vincent Leymarie ◽  
Anne-Cecile Galoisy ◽  
Annie Falkenrodt ◽  
Eric Epailly ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Transplant Recipient ◽  
Heart Transplant ◽  
Lymphocyte Count ◽  
Cardiac Transplant ◽  
Solid Organ ◽  
Normal Value ◽  
Post Transplant ◽  
Cardiac Transplant Recipient ◽  
Hairy Cells

Abstract Post-transplant lymphoproliferative disorders (PTLD) are a well-recognized complication of solid organ transplantation. Their incidence increases with the intensity of immunosuppression. Most of the PTLD are of B phenotype. HCL is a rare chronic B-cell malignancy, characterized by a cellular infiltration of spleen and bone marrow by large differentiated B cells, often exhibiting hair-like protrusions. To our knowledge, HCL has only been described once in a solid organ transplant recipient (kidney transplantation). We report here the first case of HCL in a cardiac transplant recipient. A 51-year old heart transplant recipient was referred to our department for investigation of a mild leuconeutropenia and thrombopenia that gradually worsened over a year. Medical history of this patient included gout crises and a heart transplantation 7 years earlier for a valvular cardiopathy following a streptococcal endocarditis and a Bjork valvular replacement. Immunosuppression consisted of cyclosporine and prednisone. Several episodes of acute rejection required corticosteroid boluses. At admission, patient presented with normal physical examination and no recent infectious complication. Blood cell count was as follows: WBC 1.4 x 109/L, neutrophils 0.78 x 109/L, lymphocytes 0.56x109/L, presence of rare hairy cells, hemoglobin 12.3 g/dL, platelets 140 x 109/L. CD4+ lymphocyte count was low (0.140 x 109/L). Bone marrow cytology and histopathology confirmed the diagnosis of HCL with a decreased cellularity, an infiltration by 28% hairy cells and no fibrosis. Serum levels of soluble IL-2 receptors were markedly increased at 1827 pmol/L for a upper limit of normal value of 115 pmol/L. Renal function was mildly impaired (serum creatinine: 139 μmol/L). Liver function tests were within normal range. Pentostatin therapy was initiated at a dose of 4mg/m². Six cycles were administered, every two weeks for the three first and every three weeks for the three latest. First cycle was complicated by a grade 3 febrile neutropenia. Digestive tract tolerance was poor with grade 2 nausea and vomiting after each of the 6 cycles in spite of ondansetron prophylaxis. Patient also presented a gout crisis after each of the cycle despite allopurinol and oral hydration. Post-transplant immunosuppressive regimen was not modified during the chemotherapy. No episode of rejection occurred during and after chemotherapy. No antimicrobial prophylaxis was administered. Neutrophil and platelet counts normalized after the 2nd cycle. Lymphocyte count decreased below 0.1 x 109/L after first cycle and subsequently increased slowly to return to pretreatment value only 12 months after end of therapy without occurrence of any opportunistic infection. Serum level of soluble IL-2 receptors returned to normal value after cycle 3. A bone marrow biopsy performed after 6 courses of pentostatin confirmed complete remission and chemotherapy was discontinuated. With a follow-up of 32 months after diagnosis, patient is alive, in hematological remission and has a good graft function. We can conclude from this case report that pentostatin therapy given for 6 cycles did not lead to major infectious complications in our heart-transplant patient and provided a sustained complete response.

scholarly journals Post-Transplant Outcome of the Highly Sensitized Patient Awaiting Heart Transplant Treated with Desensitization

2021 ◽  
Vol 40 (4) ◽  
pp. S44
Author(s):  
J.A. Kobashigawa ◽  
M. Kittleson ◽  
C. Villa ◽  
T. Singer-Englar ◽  
N. Patel ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Transplant Outcome ◽  
Post Transplant

scholarly journals Heart transplantation in the era of COVID-19 pandemic: delirium, post-transplant depression, and visitor restrictions; the role of liaison and inpatient psychosomatic treatment—a case report

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Monika Sadlonova ◽  
Birgit Gerecke ◽  
Christoph Herrmann-Lingen ◽  
Ingo Kutschka
Keyword(s):  
Social Isolation ◽  
Mental Health Professionals ◽  
Heart Transplant ◽  
Oral Intake ◽  
Psychotic Symptoms ◽  
Orthotopic Heart Transplant ◽  
Post Transplant ◽  
Increased Risk ◽  
End Stage

Abstract Background Heart transplant recipients show a high risk of developing major depression with an increased risk of post-transplant morbidity and mortality. Heart transplant specialists and patients face unprecedented challenges during the COVID-19 pandemic, which have enormous clinical implications such as the increased risk of COVID-19 as well as visitor restrictions with social isolation during the post-transplant inpatient treatment. Case summary We present a case of a 64-year-old woman with end-stage heart failure caused by non-compaction cardiomyopathy who received an orthotopic heart transplant (OHT) without any intra-operative complications. Post-operatively, she showed acute psychotic symptoms in the intensive care unit (ICU) with improvement after switching intravenous tacrolimus treatment to an oral intake. Furthermore, the patient developed severe depressive symptoms with malnutrition and had a prolonged hospitalization. Standard medical care was complemented by intensive psychocardiological treatment to overcome the crisis. Conclusion High complexity of the post-transplant management after OHT underlines the importance of multidisciplinary teamwork, involving heart transplant specialists and allied mental health professionals. This collaboration led to an excellent long-term result. Facing the COVID-19 pandemic, the hospital visitor policies may be scrutinized, carefully looking at the role of social isolation, post-operative experience in the ICU, and medical complications after OHT.

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