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[Orthotopic liver transplantation following heart transplantation]
K W Fritz1, H Bunzendahl, B Ringe
1Zentrum Anasthesiologie, Abteilung I, Medizinische Hochschule Hannover.
Insights
A heart transplant recipient with hepatitis B experienced liver failure due to immunosuppression. A subsequent liver transplant was necessary, but the patient ultimately succumbed to myocardial infarction.
Area of Science:
- Cardiology
- Hepatology
- Immunology
Background:
- A 24-year-old male with dilated cardiomyopathy underwent heart transplantation.
- The patient was concurrently infected with hepatitis B virus (HBV) without seroconversion.
Observation:
- Post-transplant immunosuppression led to exacerbated hepatitis B, progressing to hepatic dystrophy and precoma.
- This critical phase coincided with congruent rejection of the heart transplant.
Findings:
- A subsequent liver transplantation was performed.
- Hemodynamic parameters, including cardiac output, initially stabilized after hepatic vessel anastomosis release.
Implications:
- This case highlights the complex interplay between immunosuppression, viral hepatitis, and organ transplantation.
- Careful management of co-existing viral infections is crucial in transplant recipients.
Abstract:
Heart transplantation was performed in a 24-year-old man suffering from dilated cardiomyopathy who was also infected with hepatitis B virus and had not yet seroconverted. Most likely due to the immunosuppression, the hepatitis exacerbated and soon led to hepatic dystrophy and precoma. In this phase of congruent rejection of the heart transplant, liver transplantation was performed. During the procedure the patient had stable circulatory parameters and a reduced cardiac output. The heart rate and cardiac output stabilized after release of the anastomosis of the hepatic vessels. The patient survived for 6 months and died at home with signs of a myocardial infarction.