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Child with Heart Transplant: Unique Immunologic and Hemodynamic Issues and Their Management

  • Neha Bansal
  • Swati Sehgal
  • Celeste T. Williams
Chapter

Abstract

Heart transplant is indicated in children with heart failure secondary to dilated cardiomyopathy refractory to standard medical therapy, in children with congenital heart disease that is not amenable to surgical repair, and in children with failed palliation of congenital heart disease. Heart transplant recipients can pose a unique challenge to emergency room physicians with regard to clinical presentation, diagnostic testing, and therapeutic interventions warranted. The ER physician is the first to identify and possibly initiate treatment for the common complications seen after heart transplantation. The most common posttransplant complications are acute allograft rejection, life-threatening infections, adverse reactions to immunosuppressants, as well as certain malignancies, such as posttransplant lymphoproliferative disease (PTLD). In this chapter, we discuss the presentation and initial diagnostic and therapeutic steps in the management of patients with acute allograft rejection and infections—two most common indications for heart transplant recipients to present to the emergency room. Ultimately, it is important to have a high index of suspicion for the common complications of heart transplant as timely initiation of treatment is essential to decrease morbidity and mortality in this population. To achieve favorable outcomes, close consultation with the primary heart transplant team is essential for management of these complex and fragile patients.

Keywords

Heart transplant Rejection Immunocompromised 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Neha Bansal
    • 1
  • Swati Sehgal
    • 1
  • Celeste T. Williams
    • 2
  1. 1.Division of Pediatric Cardiology, Carmen and Ann Adams Department of PediatricsWayne State University School of Medicine, Children’s Hospital of MichiganDetroitUSA
  2. 2.Division of Cardiovascular Medicine, Henry Ford HospitalHeart and Vascular InstituteDetroitUSA

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