Left ventricular hypertrophy associated with the use of tacrolimus is a rare complication of solid organ transplantation in adult recipients. We present a cardiac transplant recipient who developed severe concentric left ventricular hypertrophy with congestive heart failure related to myocardial hypertrophy on tacrolimus. Hypertrophy improved when the drug was discontinued and replaced with sirolimus.
Adult ; Cardiomyopathy, Hypertrophic ; chemically induced ; diagnosis ; Female ; Heart Transplantation ; adverse effects ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Middle Aged ; Tacrolimus ; adverse effects ; therapeutic use

Gastrointestinal complications may follow organ transplantation. A patient who underwent heart lung transplantation due to patent ductus arteriosus and Eisenmenger's syndrome had an episode of acute cardiac rejection and was treated with a bolus injection of methylprednisolone followed by a high oral dose of prednisone. On the 22nd postoperative day, the patient complained of acute abdominal pain with muscular rigidity and a plain chest x-ray showed free air in the right subdiaphragmatic area. Under the suspicion of bowel perforation, an emergency laparotomy was performed and the perforated stomach had a wedge-shaped resection that included the perforation. Following the laparotomy, the postoperative course was uneventful and the patient was discharged on post-laparotomy day 10.
Adult ; Heart-Lung Transplantation/*adverse effects ; Human ; Male ; Peptic Ulcer Perforation/*etiology/*surgery ; Stomach Ulcer/*surgery

Coronary Artery Disease ; diagnosis ; etiology ; Graft Occlusion, Vascular ; diagnosis ; etiology ; Heart Transplantation ; adverse effects ; Humans

Adolescent ; Female ; Heart Failure ; etiology ; Humans ; Lung Transplantation ; adverse effects ; Postoperative Complications

The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation (LT) waiting list. A steady increase in the threshold at which age is taken into consideration for LT has been observed. This retrospective cohort study recruited 166 lung transplant recipients aged ≽ 65 years between January 2016 and October 2020 in the largest LT center in China. In the cohort, subgroups of patients aged 65-70 years (111 recipients, group 65-70) and ≽ 70 years (55 recipients, group ≽ 70) were included. Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years. A significantly higher percentage of coronary artery stenosis was observed in the group ≽ 70 (30.9% vs. 14.4% in group 65-70, P = 0.014). ECMO bridging to LT was performed in 5.4% (group 65-70) and 7.3% (group ≽ 70) of patients. Kaplan-Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality. After adjusting for potential confounders, cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality (HR 6.37, P = 0.0060). Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.
Aged ; Humans ; East Asian People ; Heart Diseases/etiology* ; Lung Transplantation/adverse effects* ; Retrospective Studies

BACKGROUNDMore patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation.

METHODSA retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients.

RESULTSAll patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results.

CONCLUSIONSImmunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.

Adolescent ; Adult ; Female ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Liver Transplantation ; Male ; Middle Aged ; Organ Transplantation ; Surgery, Plastic ; adverse effects ; methods ; Young Adult

PURPOSE: Homograft benefits include excellent hemodynamics, resistance to infection, decreased thromboembolic events, ease of handling, and lack of need for anticoagulation. We examined the short and mid-term results of right ventricular outflow tract (RVOT) reconstruction using cryopreserved homografts. PATIENTS AND METHODS: From May 1998 to May 2005, 20 patients (male:female=10:10) underwent RVOT reconstruction using cryopreserved homografts. The median age was 23.8 years (range, 0.9 to 43.3 years) and the median body weight was 57kg (range, 7.3 to 80kg). Eighteen patients underwent re-operation after shunt or corrective operations. Homograft failure was defined as either re-operation for homograft replacement or patient death. Homograft dysfunction was defined as grade 3 or more than 3 of graft regurgitation and more than 40mmHg of transvalvular pressure gradient under echocardiographic examination. RESULTS: No operative mortality occurred and there were three major complications. Graft failure was observed in one male patient with tetralogy of Fallot. The 8-year freedom from graft failure was 87.5+/-11.7% and the 7-year freedom from graft dysfunction was 62.3+/-17.9%. Multivariable analysis revealed that the independent factor for graft dysfunction was age less than 10 years. In the analysis according to age group, the 7-year freedom from graft dysfunction in the group of patients older than 10 years was 100% and 25.0+/-21.7% in patients age 10 or younger (p= 0.03). CONCLUSION: Right ventricular outflow reconstruction using cryopreserved homografts provided excellent short and mid-term results in most patients in this study. However, in patients younger than 10 years old, homografts for RVOT reconstruction showed a high dysfunction rate at mid-term.
Adolescent ; Adult ; Child ; Child, Preschool ; Cryopreservation ; Female ; Heart Diseases/*surgery ; Heart Ventricles/*transplantation ; Humans ; Infant ; Intraoperative Complications ; Male ; Postoperative Complications ; Transplantation, Homologous/adverse effects ; Treatment Outcome

PURPOSE: The arrhythmogenic effect of stem cells transplantation (SCT) in an infarct myocardium is still unknown. We investigated arrhythmogenicity of SCT in rat cryo-infarct model. MATERIALS AND METHODS: In rat cryo-infarct model, bone marrow mononuclear stem cells (MNSC, 1 x 10(7) cells) were transplanted into the infarct border zone (BZ) of the LV epicardium. We compared the optical mapping and inducibility of ventricular tachycardia/fibrillation (VT/VF) among normal (n=5), cryo-infarct (n=6), and SCT rats (n=6). RESULTS: The VT/VF inducibility was higher in the cryo- infarct (47.2%, p=0.001) and SCT groups (34.6%, p=0.01) than in the normal group (12.8%). The induced VT/VF episodes persisted for more than 2 minutes in 4.3%, 26.4% and 17.3% in the normal, cryo-infarct and SCT group, respectively. In the SCT group, the action potential duration at 70% was shorter at the SCT site than the BZ during SR (75.2 +/- 8.1 vs. 145.6 +/- 4.4 ms, p=0.001) and VT (78.2 +/- 13.0 vs. 125.7 +/- 21.0 ms, p= 0.001). Conduction block was observed at the SCT site and BZ during VT. However, no reentry or ectopic foci were observed around the SCT sites. CONCLUSION: The electrical conduction was improved by SCT without evidence of augmentation of arrhythmia in the rat cryo-infarct model.
Action Potentials ; Animals ; Arrhythmias, Cardiac/*etiology ; Bone Marrow Transplantation/*adverse effects ; Disease Models, Animal ; Electric Conductivity ; Heart Ventricles/pathology/transplantation ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Myocardial Infarction/pathology/*surgery ; Rats ; Rats, Sprague-Dawley

Cardiac arrest during upper abdominal surgery such as liver transplantation is a rare but very severe complication. Traditional external cardiac compression has been the mainstay of basic life support in general circumstances. Subdiaphragmatic cardiac compression (SDCC), with no incision in the diaphragm, may be a more effective measure. This maneuver can provide more effective and timely cardiac compression via the already open abdomen in surgery and not add extra trauma. This method can provide a quicker and more effective means of circulation support for intraoperative cardiac arrest patients without adding new injuries. Five cases are reported and all the patients had return of spontaneous circulation (ROSC). This is the first report of the SDCC method.
Adult ; Cardiopulmonary Resuscitation ; methods ; Female ; Heart Arrest ; etiology ; therapy ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged

OBJECTIVETo investigate the safety and efficacy of basiliximab as induction agent in preventing early acute rejection post heart transplantation.

METHODSBasiliximab (20 mg, iv) was administered one hour before and 4 days post operation to patients (n = 47) underwent heart transplantation between June 2004 and Feb 2005 in our department. Intravenous methylprednisolone (500 mg at operation beginning and repeated immediately post operation, followed by 125 mg every 8 hours for the first day). Prednisone was then initiated at 1 mg.kg(-1).d(-1) tapered 10 mg every 3 days to 10 mg/d. Mycophenolate mofetil (MMF, 0.5 - 1.0 g twice daily) was also administered post intubation, oral Cyclosporine A (CsA, 3 to 6 mg.kg(-1).d(-1)) was prescribed after transplantation if serum creatinine was < 150 micromol/L. The dose of CsA was individually adjusted to achieve a target serum concentration of 180 - 300 ng/ml. Endomyocardial biopsies were performed 3 weeks (19.7 +/- 9.6) d post heart transplantation. Biopsy specimens were graded according to the standardized criteria of the International Society for Heart and Lung Transplantation (ISHLT). Echocardiograms were routinely performed weekly within the first 3 weeks post-operation.

RESULTSAll 47 consecutive patients [mean age (44.9 +/- 13.4) years, range 13 - 63 years, 38 men] survived the operation and the underlying diseases was idiopathic cardiomyopathy (42.5%), ischemic heart disease (25.5%), arrhythmogenic right ventricular cardiomyopathy (17.0%), hypertrophic cardiomyopathy (4.2%), heart tumor (4.25%), valve heart disease (2.1%), hypertensive cardiomyopathy (2.1%) and giant cell myocarditis (2.1%). There were 4 patients with pre-operation PRA > 10% and CDC was less than 5% in all patients. The grades of the acute rejection in biopsy specimens were as follow: Grade (G) 0 in 30 (63.8%), G IA in 11 (23.4%), G IB in 3 (6.3%) and GII in 3 (6.3%) patients. The average dose of MMF was (1.2 +/- 0.3) g/d. The initial time of receiving CsA was (3.4 +/- 2.1) day post operation. The average cumulative dose of CsA was (4.1 +/- 1.2) mg.kg(-1).d(-1) before endomyocardial biopsy. The average serum concentration of CsA was (237.0 +/- 76.2) ng/ml. Left ventricular ejection fraction assessed by echocardiogram was normal in all patients within the first 3 weeks. Five patients suffered from respiratory infections and recovered post antibiotic and symptomatic therapies.

CONCLUSIONBasiliximab as induction agent in combination with conventional triple immunosuppressive therapy is safe and effective in preventing acute rejection in Chinese cardiac transplantation receipts.

Adolescent ; Adult ; Antibodies, Monoclonal ; adverse effects ; therapeutic use ; Female ; Graft Rejection ; prevention & control ; Heart Transplantation ; adverse effects ; immunology ; Humans ; Male ; Middle Aged ; Recombinant Fusion Proteins ; adverse effects ; therapeutic use ; Young Adult