Non-invasive monitoring of acute rejection after heart transplantation

Abstract

Objective To evaluate the effect and safety of noninvasive monitoring during episodes of acute rejection after heart transplantation.Methods Since April 2001 to June 2013,totally 31 homogeneous orthotopic heart transplants were performed.During the operation,500 mg methylprednisolone sodium succinate was used for anti-rejection treatment after anaesthesia.In order to avoid the acute rejection,another 500 mg methylprednisolone sodium succinate was given before aortic-clamp opened.After the operation,we choose a new triple therapy as the standard of anti-rejection treatment after the heart transplantation.CsA or FK506,prednisone metacortandracin and the CellCept.Since 2009,Simulect was used during the operation and the forth day after the operation.Acute rejection after transplantation was monitored by noninvasive monitoring including clinical features,body surface electrocardiogram,echocardiography,thoracic radiograph,and myocardial enzymogram.Results Among all the patients,3 cases (9.7％) died of the pulmonary hypertension,and right heart failure secondary to multiple organ failure such as the kidney or pulmonary; 28 patients of the group had a quick recovery and discharge,and one of them die of fungal infection about one and a half years after the operation.Two patients had acute rejections,the first one was happened two months postoperation and another was about four years later,both of them were relieved by using a large amount of methylprednisolone,all the clinical index took a turn for the better.The acute rejection did not happen to the other 26 patients after the heart transplantation.One patient took a chronic hemodialysis because of the renal failure 12 years after the surgery.Conclusions Noninvasive monitoring was a sensitive,reliable and non-invasive approach monitoring acute rejection after heart transplantation.It was especially suitable for monitoring anti-rejection therapy.Their combination was proved to be of great value in and screening of cardiac allograft rejection.It is the premise for perioperative and postoperative positive,rational anti-rejection therapy to reduce the acute rejection. Key words: Heart transplantation ;  Postoperative complications ;  Graft rejection/diagnosis ;  Graft rejection/etiology ;  Echocardiography ;  Electrocardiography ;  Radiography;  Myocardium/enzymology