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Updated: Jun 27, 2026
Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation
Published on: May 2, 2013
[Individual immunosuppressive regime in heart transplantation with high risk]
Xi-jie Wu1, Liang-wan Chen, Dao-zhong Chen
1Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China. xwk_wxj@tom.com
Insights
Tailoring immunosuppressive regimens for high-risk heart transplant patients, including those with Hepatitis B virus (HBV) infection, diabetes mellitus, or renal dysfunction, can minimize mortality and acute rejection episodes. This individualized approach ensures better patient outcomes post-transplantation.
Area of Science:
- Cardiology
- Immunology
- Transplantation Medicine
Context:
- Heart transplantation presents significant challenges for high-risk patients.
- Comorbidities such as Hepatitis B virus (HBV) infection, diabetes mellitus, and renal dysfunction complicate post-transplant management.
- Perioperative complications like pulmonary infections require careful attention.
Purpose:
- To summarize the clinical experience of individualized immunosuppressive regimens in high-risk heart transplant recipients.
- To evaluate the efficacy and safety of tailored immunosuppression in managing specific patient populations.
- To assess the impact of individualized protocols on mortality and acute rejection rates.
Summary:
- A retrospective analysis of 51 high-risk heart transplant patients from 2001-2006 was conducted.
- Patients received daclizumab induction with baseline triple immunosuppression (cyclosporine, azathioprine/mycophenolate mofetil, prednisone), with modifications based on individual risk factors.
- Specific protocols were implemented for HBV infection, diabetes mellitus, renal dysfunction, and pulmonary infections, including adjustments in medication and dosage.
Impact:
- Individualized immunosuppressive strategies are associated with low mortality rates in high-risk heart transplant recipients.
- Appropriate regimen selection significantly reduces the incidence of acute rejection.
- This approach demonstrates the feasibility of managing complex patient profiles in heart transplantation.
Objective:
To Summarize the clinical experience of individual immunosuppressive regime in heart transplantation with high risk.
Methods:
From September 2001 to December 2006, 51 cases with the complication of Hepatitis B viruses (HBV) infection, diabetes mellitus, renal dysfunction or pulmonary infection in perioperative period were analyzed retrospectively. All cases received daclizumab (Zenapax) induction therapy, and baseline triple immunosuppressive regime was consist of cyclosporine (CsA), azathioprine (Aza) or mycophenolate mofetil (MMF) and prednisone (Pred). Ten cases received HBV infection in preoperative period, the immunosuppressive protocol was emphasized on the use of MMF and the withdraw of Pred one month later in postoperation. Nine cases received diabetes mellitus in pre-operation, 4 cases had post-transplant diabetes mellitus. The immunosuppressive protocol was emphasized on the use of CsA rather than FK506, the use of Pred was less dosage, and the therapy of insulin was necessary. Sixteen cases had renal dysfunction in pre-operation, the use of MMF was routine but the use of CsA was delayed to the time 5 to 19 d postoperative. Twelve cases received pulmonary infection after allograft transplantation. The immunosuppressive agent was to be taped or suspended in therapy time.
Results:
The liver function of the 10 cases with HBV infection was stable in 1 year follow-up, and 1 case received acute rejection after 13 months allograft transplantation. In the 6 months follow-up, the blood glucose level of the 13 cases with diabetes mellitus was stable, none of the cases suffered from acute rejection. In the one month follow-up, none of the 16 cases with renal dysfunction suffered from acute rejection, and the renal function was normal. Two of the 12 cases with the pulmonary infection were died of serious infection, others were survival. One case received acute rejection on the 17th day in postoperation.
Conclusions:
Low mortality can be realized by selecting appropriately individual immunosuppressive regime and the episode of acute rejection is rare.
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