Cardiac transplantation

1. CARDIAC TRANSPLANTATION
AN OVERVIEW
Raja Lahiri

12. DIAGNOSIS PERCENTAGE OF RECIPIENTS
Ischaemic cardiomyopathy 45%
Dilated cardiomyopathy 45%
Valvular Heart Disease 4%
Congenital Heart Disease 2%
Redo- transplantation 2%
Miscellaneous 2%

13.  Results of transplantation have improved because
of:
1. Improvement of surgical technique
2. Immunosuppressant drugs
3. Improvement in infection prophyllaxis

14. CONTRAINDICATIONS
ABSOLUTE RELATIVE
PVR>4 wood units Age>65yrs
Creat. clearance<50ml/kg/min BMI> 30Kg/m²
Bilirubin> 3 mg/dL Osteoporosis
Malignancy Peptic ulcers
Acute inflammatory conditions Psychosis
DM with 2° organ damage Non compliant with treatment

51. ENDOMYOCARDIAL BIOPSY
 Percutaneous procedure
 Uses an instrument known as ‘Bioptome’
 Access: through IJV> TV> RV
 Biopsy taken at 4-6 places to reduce sample error
 Alternatives to biopsy include Cardiac MRI, EP
monitoring, Prothrombin factors, ANP, Troponin etc.

52. ENDOMYOCARDIAL BIOPSY
SCHEDULE
Weeks after transplant Biopsy frequency
1-4 Weekly
5-12 Every 2 weeks
13-24 Monthly
25-52 Every 2 months
Year 2 Every 3-4 months
Year 3-4 Every 6 months
>4 years Only if clinically indicated
After biopsy with acute rejection 2 wk after initial biopsy

53. RISK FACTORS FOR RECURRENT
ACUTE REJECTION
 Shorter interval between two successive episodes
 Young age
 Female recipients
 Female donor
 CMV positive
 Infection
 OKT3 induction

54. MANAGEMENT OF ACUTE REJECTION
EARLY/SEVERE LATE/MILD
Methylprednisolone Prednisolone
Antilymphocyte antibody Adjustment of maintainance doses
Plasmapheresis, AZT, MTX