[Heart transplantation: successful treatment of postoperative complications. Case report with 19 months' follow-up]
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This study details the first German cardiac transplant since 1969, focusing on immunosuppression strategies. The patient experienced complications but recovered well, highlighting effective immunosuppressive therapy for heart transplant recipients.
Area of Science:
- Cardiology
- Immunology
- Surgical Innovation
Background:
- The case report details a patient undergoing cardiac transplantation in Germany, the first since 1969.
- The patient presented with end-stage coronary artery disease, necessitating the intervention.
Observation:
- Immunosuppression involved antithymocyte globulin, azathioprine, and corticosteroids, guided by T-lymphocyte counts and myocardial biopsies.
- The patient experienced gastrointestinal complications, including a perforated gastric ulcer and small intestine perforation.
- Experience was gained with antithymocyte globulin, administered at up to 12 mg/kg daily for over six weeks.
Findings:
- Comparative analysis of cyclosporin A administration (oral, intravascular, intravenous) was possible due to treatment alterations.
- The patient's condition remained good on a maintenance regimen of cyclosporin A and corticosteroids.
- Antithymocyte globulin demonstrated effectiveness in the early postoperative phase.
Implications:
- Alternating immunosuppressive regimens (antithymocyte globulin, azathioprine, corticosteroids vs. cyclosporin A, corticosteroids) may minimize adverse reactions and optimize immunosuppression.
- This experience offers valuable insights for managing patients post-cardiac transplantation.
- The study underscores the importance of tailored immunosuppressive strategies in heart transplant recipients.
Abstract:
In March, 1981, a 37-year old patient underwent cardiac transplantation, the first to be performed in Germany since 1969. Subsequent to the successful procedure, the patient has now been followed for more than 19 months. The indication for the intervention was established on the basis of endstage coronary artery disease. The operation was performed according to the technique of Lower and Shumway. Immunosuppression, in the early postoperative phase, was carried out with antithymocyte globulin, azathioprine and corticosteroids with administration oriented on the T-lymphocyte and total leukocyte counts as well as analysis of myocardial biopsies. In the late postoperative course, dosage of immunosuppressive agents was based almost exclusively on biopsy findings. Within the course of immunosuppressive therapy for cardiac transplantation, in particular, initial experience was gained with the use of antithymocyte globulin which was given in dosages of up to 12 mg/kg daily. The antithymocyte globulin proved effective for more than six weeks postoperatively. The alterations in immunosuppressive treatment necessitated by two gastrointestinal complications (perforated gastric ulcer, perforation of the small intestine) enabled a comparative analysis of the results of therapy with cyclosporin A given orally, intravascularly and intravenously. The Patient continues to be maintained on a regimen of cyclosporin A and corticosteroids and his general condition is good. For future cardiac transplantations, in the early postoperative course, alternating treatment with antithymocyte globulin, azathioprine and corticosteroids, on the one hand, with cyclosporin A and corticosteroids, on the other hand, would seem meaningful both to minimize adverse reactions as well as to provide effective immunosuppression. The experience rendered would promise to facilitate management of patients after cardiac transplantation.