Cardiac transplantation for probable cocaine-related cardiomyopathy and retransplantation after biventricular support

A 20-year-old woman presented with a dilated cardiomyopathy and a history of drug abuse, including the regular use of cocaine. After 18 months of medical therapy, her condition deteriorated, and she required cardiac transplantation. She received a “domino donor” heart from a patient with end-stage lung disease and pulmonary hypertension. She was readmitted 8 months later with severe rejection and cardiac failure, and required biventricular mechanical support. After 18 days she was successfully retransplanted, despite acute renal failure and several infective problems.