Skip to main content

Clinical Management of Transplant Recipients

  • Chapter
  • First Online:
The Pathology of Cardiac Transplantation

Abstract

Decades after the first heart transplant was performed, the clinical management of heart transplant recipients is still challenging. This chapter will recount the main aspects of selection of heart failure patients for transplantation. A summary of the main mechanisms of the most commonly used immunosuppressive drugs is given, as well as the main antirejection protocols, including related problems. Management of heart transplant recipients involves not only immunosuppression but also a global medical approach, according to the different phases of transplantation: during surgery, in the early postoperative period, and in the long-term follow-up. Some insights into the most frequently used instrumental diagnostic techniques and into the new research topics are also briefly presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aliabadi AZ, Grömmer M, Dunkler D, Eskandary F, Salameh O, Gökler J, Hutschala D, Steinlechner B, Opfermann P, Laufer G, Zuckermann AO. Impact of rabbit antithymocyte globulin dose on long-term outcomes in heart transplant patients. Transplantation. 2016;100(3):685–93.

    Article  CAS  PubMed  Google Scholar 

  • Ansari D, Lund LH, Stehlik J, Andersson B, Höglund P, Edwards L, Nilsson J. Induction with anti-thymocyte globulin in heart transplantation is associated with better long-term survival compared with basiliximab. J Heart Lung Transplant. 2015;34(10):1283–91.

    Article  PubMed  Google Scholar 

  • Baselga J, Campone M, Piccart M, et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med. 2012;366:520.

    Article  CAS  PubMed  Google Scholar 

  • Campara M, Tzvetanov IG, Oberholzer J. Interleukin-2 receptor blockade with humanized monoclonal antibody for solid organ transplantation. Expert Opin Biol Ther. 2010;10(6):959–69.

    Article  CAS  PubMed  Google Scholar 

  • Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29:914–56.

    Article  PubMed  Google Scholar 

  • Dobbels F, Berben L, De Geest S, Drent G, Lennerling A, Whittaker C, Kugler C. The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: a systematic review. Transplantation. 2010;90(2):205–19.

    Article  PubMed  Google Scholar 

  • Eisen HJ, Tuzcu EM, Dorent R, Kobashigawa J, Mancini D, Valantine-von Kaeppler HA, Starling RC, Sorensen K, Hummel M, Lind JM, Abeywickrama KH, Bernhardt P. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. N Engl J Med. 2003;349(9):847–58.

    Article  CAS  PubMed  Google Scholar 

  • Eisen HJ, et al. Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial. Am J Transplant. 2013;13:1203–16.

    Article  CAS  PubMed  Google Scholar 

  • Epailly E, Albanell J, Andreassen A, et al. Proliferation signal inhibitors and post-transplant malignancies in heart transplantation: practical management questions. Clin Transplant. 2011;25:E475–86.

    Article  CAS  PubMed  Google Scholar 

  • Fiocchi R, D’Elia E, Vittori C, Sebastiani R, Strobelt N, Eleftheriou G, Introna M, Freddi C, Crippa A. First report of a successful pregnancy in an everolimus-treated heart-transplanted patient: neonatal disappearance of immunosuppressive drugs. Am J Transplant. 2016;16(4):1319–22.

    Article  CAS  PubMed  Google Scholar 

  • Griffiths PD, Cope AV, Hassan-Walker AF, et al. Diagnostic approaches to cytomegalovirus infection in bone marrow and organ transplantation. Transpl Infect Dis. 1999;1(3):179–86.

    Article  CAS  PubMed  Google Scholar 

  • Grigioni F, Potena L, Galiè N, Fallani F, et al. Prognostic implications of serial assessments of pulmonary hypertension in severe chronic heart failure. J Heart Lung Transplant. 2006;25(10):1241–6.

    Article  PubMed  Google Scholar 

  • Jahania MS, Sanchez JA, Narayan P, Lasley RD, Mentzer RM. Heart preservation for transplantation: principles and strategies. Ann Thorac Surg. 1999;68:1983–7.

    Article  CAS  PubMed  Google Scholar 

  • Jeon HJ, Kim H, Yang J. Bone disease in post-transplant patients. Curr Opin Endocrinol Diabetes Obes. 2015;22(6):452–8.

    Article  CAS  PubMed  Google Scholar 

  • Jordan SC, Toyoda M, Vo AA. Intravenous immunoglobulin a natural regulator of immunity and inflammation. Transplantation. 2009;88(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  • Kaczmarek I, Deutsch MA, Sadoni S, Brenner P, Schmauss D, Daebritz SH, Weiss M, Meiser BM, Reichart B. Successful management of antibody-mediated cardiac allograft rejection with combined immunoadsorption and anti-CD20 monoclonal antibody treatment: case report and literature review. J Heart Lung Transplant. 2007;26(5):511–5.

    Article  PubMed  Google Scholar 

  • Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Miller MA, Baldwin JT, Young JB. Sixth INTERMACS annual report: a 10000-patient database. J Heart Lung Transplant. 2014;33:555–64.

    Article  PubMed  Google Scholar 

  • Kittleson MM, Kobashigawa JA. Antibody-mediated rejection. Curr Opin Organ Transplant. 2012;17(5):551–7.

    Article  CAS  PubMed  Google Scholar 

  • Kobashigawa J, Miller L, Renlund D, Mentzer R, Alderman E, Bourge R, Costanzo M, Eisen H, Dureau G, Ratkovec R, Hummel M, Ipe D, Johnson J, Keogh A, Mamelok R, Mancini D, Smart F, Valantine H. A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients. Mycophenolate Mofetil Investigators. Transplantation. 1998;66(4):507–15.

    Article  CAS  PubMed  Google Scholar 

  • Kobashigawa JA, Miller LW, Russell SD, Ewald GA, Zucker MJ, Goldberg LR, Eisen HJ, Salm K, Tolzman D, Gao J, Fitzsimmons W, First R, Study Investigators. Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report. Am J Transplant. 2006;6(6):1377–86.

    Article  CAS  PubMed  Google Scholar 

  • Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, Mancini D, Patel J, Razi R, Reichenspurner H, Russell S, Segovia J, Smedira N, Stehlik J, Wagner F, Consensus Conference Participants. Report from a consensus conference on antibody-mediated rejection in heart transplantation. J Heart Lung Transplant. 2011;30:252–69.

    Article  PubMed  Google Scholar 

  • Kobashigawa J, Zuckermann A, MacDonald P, Leprince P, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33:327–40.

    Article  PubMed  Google Scholar 

  • Kotton CN, Kumar D, Caliendo AM, et al. International consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation. 2010;89:779.

    Article  PubMed  Google Scholar 

  • Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, Mestroni L, Page 2nd RL, Kobashigawa J. Drug therapy in the heart transplant recipient. Part II: immunosuppressive drugs. Circulation. 2004;110(25):3858–65.

    Article  CAS  PubMed  Google Scholar 

  • Lindenfeld J, Page 2nd RL, Zolty R, Shakar SF, Levi M, Lowes B, Wolfel EE, Miller GG. Drug therapy in the heart transplant recipient. Part III: common medical problems. Circulation. 2005;111(1):113–7.

    Article  PubMed  Google Scholar 

  • Lyons JB, Chambers FA, MacSullivan R, Moriarty DC. Anaesthesia for non-cardiac surgery in the post-cardiac transplant patient. Ir J Med Sci. 1995;164(2):132–5.

    Article  CAS  PubMed  Google Scholar 

  • Martin ST, Kato TS, Farr M, McKeen JT, Cheema F, Ji M, Ross A, Yerebakan H, Naka Y, Takayama H, Restaino S, Mancini D, Schulze PC. Similar survival in patients following heart transplantation receiving induction therapy using daclizumab vs. basiliximab. Circ J. 2015;79(2):368–74.

    Article  PubMed  Google Scholar 

  • Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, Danziger-Isakov L, Kirklin JK, Kirk R, Kushwaha SS, Lund LH, Potena L, Ross HJ, Taylor DO, Verschuuren EAM, Zuckermann A. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35(1):1–23.

    Article  PubMed  Google Scholar 

  • Morken NH, Diaz-Garcia C, Reisaeter AV, Foss A, Leivestad T, Geiran O, Hervás D, Brännström M. Obstetric and neonatal outcome of pregnancies fathered by males on immunosuppression after solid organ transplantation. Am J Transplant. 2015;15(6):1666–73.

    Article  PubMed  Google Scholar 

  • Motzer RJ, Escudier B, Oudard S, et al. Phase 3 trial of everolimus or metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer. 2010;116:4256.

    Article  CAS  PubMed  Google Scholar 

  • Potena L, Holweg CT, Chin C, Luikart H, Weisshaar D, Narasimhan B, Fearon WF, Lewis DB, Cooke JP, Mocarski ES, Valantine HA. Acute rejection and cardiac allograft vascular disease is reduced by suppression of subclinical cytomegalovirus infection. Transplantation. 2006;82(3):398–405.

    Article  CAS  PubMed  Google Scholar 

  • Potena L, Grigioni F, Magnani G, et al. Prophylaxis versus pre-emptive anti-cytomegalovirus approach for prevention of allograft vasculopathy in heart transplant recipients. J Heart Lung Transplant. 2009;28:461–7.

    Article  PubMed  Google Scholar 

  • Salgo R, Gossmann J, Schofer H, et al. Switch to a sirolimus-based immunosuppression in long-term renal transplant recipients: reduced rate of (pre)-malignancies and non melanoma skin cancer in a prospective, randomized, assessor-blinded, controlled clinical trial. Am J Transplant. 2010;10:1385.

    Article  CAS  PubMed  Google Scholar 

  • Schafer-Keller P, Steiger J, Bock A, Denhaerynck K, De Geest S. Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients. Am J Transplant. 2008;8(3):616–26.

    Article  CAS  PubMed  Google Scholar 

  • Singh RK, Richmond ME, Zuckerman WA, Lee TM, et al. The use of oral sildenafil for management of right ventricular dysfunction after pediatric heart transplantation. Am J Transplant. 2014;14(2):453–8.

    Article  CAS  PubMed  Google Scholar 

  • Sirri L, Potena L, Masetti M, Tossani E, Magelli C, Grandi S. Psychological predictors of mortality in heart transplanted patients: a prospective, 6-year follow-up study. Transplantation. 2010;89(7):879–86.

    Article  PubMed  Google Scholar 

  • Stallone G, Schena A, Infante B, et al. Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med. 2005;352:1317.

    Article  CAS  PubMed  Google Scholar 

  • Stehlik J, Hosenpud JD, Edwards LB, Hertz MI, Mehra MR. ISHLT International Registry for Heart and Lung Transplantation – into fourth decade, from strength to strength. J Heart Lung Transplant. 2013;32(10):941–50.

    Article  PubMed  Google Scholar 

  • Stobierska-Dzierzek B, Award H, Michler RE. The evolving management of acute right-sided heart failure in cardiac transplant recipients. J Am Coll Cardiol. 2001;38(4):923–31.

    Article  CAS  PubMed  Google Scholar 

  • Vachièry JL, Adir Y, Barbera JA, Champion H, Coghlan JG, Cottin V, De Marco T, Galiè N, Ghio S, Gibbs JS, Martinez F, Senigram M, Simonneau G, Wells A, Seeger W. Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol. 2013;62(25 Suppl):D100–8.

    Article  PubMed  Google Scholar 

  • Whitson BA, Kilic A, Lehman A, Wehr A, Hasan A, Haas G, Hayes Jr D, Sai-Sudhakar CB, Higgins RS. Impact of induction immunosuppression on survival in heart transplant recipients: a contemporary analysis of agents. Clin Transplant. 2015;29(1):9–17.

    Article  CAS  PubMed  Google Scholar 

  • Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice guidelines. Circulation. 2013;128:e240–327.

    Article  PubMed  Google Scholar 

  • Zuckermann A, Wang SS, Epailly E, Barten MJ, Sigurdardottir V, Segovia J, Varnous S, Turazza FM, Potena L, Lehmkuhl HB. Everolimus immunosuppression in de novo heart transplant recipients: what does the evidence tell us now? Transplant Rev (Orlando). 2013;27(3):76–84.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francesco Grigioni MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Masetti, M., Grigioni, F. (2016). Clinical Management of Transplant Recipients. In: Leone, O., Angelini, A., Bruneval, P., Potena, L. (eds) The Pathology of Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-46386-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-46386-5_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46384-1

  • Online ISBN: 978-3-319-46386-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics