title: Total lymphoid irradiation as rescue therapy after heart transplantation.
abstract: BACKGROUND
  Allograft dysfunction develops in a proportion of heart transplant recipients without significant cellular infiltrate in endomyocardial biopsies and with normal coronary arteries at angiography. The mechanisms responsible for this presentation are unclear, and the prognosis is poor. We report encouraging experience with total lymphoid irradiation given in addition to cyclosporine A, cyclophosphamide, and prednisolone therapy in three heart transplant recipients with poor graft function with normal endomyocardial biopsies and coronary angiography.
  
  
  METHODS
  Three patients who had severe allograft dysfunction after orthotopic heart transplantation, with normal endomyocardial biopsies and coronary angiography, were successfully treated with total lymphoid irradiation. Biventricular failure developed in each patient despite immunosuppression with cyclosporine A, azathiaprine, oral prednisolone, cyclophosphamide, and intravenous methylprednisolone therapy. Total lymphoid irradiation was given with standard mantle and inverted y fields over 10 treatments to achieve a cumulative dose of 8 Gy.
  
  
  RESULTS
  Each patient had a significant improvement in clinical response and in ventricular performance after total lymphoid irradiation, which was well tolerated in each case. The patients remain well at 8, 9, and 12 months after completion of treatment.
  
  
  CONCLUSIONS
  Total lymphoid irradiation should be considered as adjunct therapy to conventional immunosuppression for heart transplant recipients with poor graft function in the absence of cellular rejection or coronary artery disease.
authors.affiliation: Department of Cardiological Sciences, St. George's Hospital, London, United Kingdom.
authors.forename: B P
authors.initials: BP
authors.lastname: Madden
authors.forename: L
authors.initials: L
authors.lastname: Backhouse
authors.forename: D
authors.initials: D
authors.lastname: McClosky
authors.forename: L
authors.initials: L
authors.lastname: Reynolds
authors.forename: D
authors.initials: D
authors.lastname: Tait
authors.forename: A
authors.initials: A
authors.lastname: Murday
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003602:Cytotoxicity, Immunologic / Q000528:radiation effects; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000532:radiotherapy*; D006333:Heart Failure / Q000276:immunology / Q000532:radiotherapy; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents