Side effect profile of 55 Heart Transplant patients - an Indian study

Abstract

Just before Heart Transplant, all patients received 10-20 mg of Induction with Injection Basiliximab (dose as per body weight and general condition) single dose. Second dose of Basiliximab was Given selectively in 15 patients. Post op immunosuppression regimen was Tacrolimus in 54, Tacrolimus (low dose with a target of 2-3 ng/ml) PLUS Everolimus 0.25 mg bid in 5 patients, Mycophenolate in all patients. Steriod Wysolone was given for 6 months in 45 patients and in the rest upto 1 year. Post operatively in 38 patient’s creatinine levels Normalized by day 5, allowing initiation of Tacrolimus. While in other 12 patients Tacrolimus could be started only at day 10 with NO Ill effects or rejection episodes. In all patient’s CD 25 level was checked on day 3 and second dose of basiliximab given only if CD 25 more than 3%. Post op no patient had sustained neutropenia. Only 2 patient needed therapy for Azotemia with post-operative dialysis. 3 patients died of Severe RF and sepsis [2]. 15 patients (27%) has new onset Diarrhoea in the First year after Transplant of whom 4(7%) were found to have CMV antigen Positive these resolved with IV Gancyclovir in 3. One had clostridium difficile positive diarrhoea-treated with IV Vancomycin Plus Metronidazole. In 7 patients diarrhoea resolved with termination of Mycophenolate and other 4 had E-coli or Salmonella diarrhea resolved with Oral antibiotics. One Patients had extensive Herpes Zoster which resolved with anti-Viral drug Acyclovir. One Patient had Hepatic Mucormycosis Tretaed with Amphoterecin [3].