[Aortic valve replacement in a renal transplant recipient]

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Immunology

Background:

• A 65-year-old male with end-stage renal disease (ESRD) and a history of kidney transplantation 15 years prior presented with congestive heart failure secondary to severe aortic regurgitation.
• The patient was on a stable immunosuppressive regimen of ciclosporin and mycophenolate mofetil for his renal allograft.

Observation:

• Preoperative evaluation revealed deteriorating renal allograft function with a serum creatinine level of 1.8 mg/dl.
• Surgical intervention for aortic regurgitation was deemed necessary, requiring a cryopreserved aortic allograft.

Findings:

• Aortic valve replacement was performed using a cryopreserved aortic allograft.
• Postoperatively, the patient's serum creatinine level improved to 1.5 mg/dl.
• The patient tolerated the procedure well, and immunosuppressive therapy was continued throughout the perioperative period.

Implications:

• The use of an aortic allograft in a patient with a history of organ transplantation and ongoing immunosuppression may offer advantages for future renal allograft survival.
• The patient's successful recovery and improved New York Heart Association functional class (Class I) suggest a favorable outcome.
• This case highlights the potential benefits of utilizing allograft tissue in complex cardiac surgeries for patients with a history of transplantation, considering the immunomodulatory effects of maintenance immunosuppression.