Delayed complete recovery of graft dysfunction after cardiac transplantation

Primary graft dysfunction is a major cause of morbidity and mortality early after cardiac transplantation. We present here a case of unspecific graft dysfunction in a 47-year-old female recipient of a heart transplant that could not be attributed to the unusual causes of this disorder. The patient manifested symptoms and signs of heart failure early postoperatively, and echocardiography together with right heart catheterization confirmed the diagnosis. There was no body size mismatch, graft preservation was optimal, pulmonary vascular resistance preoperatively was normal, and rejection episodes could not explain her deterioration. Standard medical therapy for heart failure was initiated, and the patient's symptoms improved, although graft dysfunction persisted for a period of 1.5 years. Afterward, a gradual spontaneous improvement occurred, resulting in complete recovery of graft function at six years postoperatively. In addition to the case presented, potential contributing factors to this syndrome, together with appropriate treatment options, are discussed.