title: Rapamycin as rescue therapy in a patient supported by biventricular assist device to heart transplantation with consecutive ongoing rejection.
abstract: Rapamycin is a new immunosuppressive agent that has been shown to be effective in acute heart allograft rejection. This case documents a patient suffering from cardiac sarcoidosis who was bridged to transplantation for 90 days with ongoing rejection after allograft implantation. Rejection did not abate despite treatment with antithymocyte globulin (ATG), FK506, a mycophenolate switch and courses of multiple apheresis. Initiation of rapamycin treatment resulted in a rapid resolution of cardiac rejection and reduction of concomitant immunosuppressive agents with few side-effects. Most notably was the reduction of panel reactive antibodies within a few weeks after the rapamycin initiation. This case illustrates that the utilization of rapamycin ceased ongoing rejection in a patient with a clear hyperimmune state despite prior extensive utilization of a variety of immunosuppressive strategies after heart transplantation.
authors.affiliation: Department of Cardiothoracic Surgery, General Hospital Vienna, Vienna, Austria. hjankersmit@hotmail.com
authors.forename: H J
authors.initials: HJ
authors.lastname: Ankersmit
authors.forename: G
authors.initials: G
authors.lastname: Roth
authors.forename: A
authors.initials: A
authors.lastname: Zuckermann
authors.forename: B
authors.initials: B
authors.lastname: Moser
authors.forename: R
authors.initials: R
authors.lastname: Obermaier
authors.forename: S
authors.initials: S
authors.lastname: Taghavi
authors.forename: M
authors.initials: M
authors.lastname: Brunner
authors.forename: G
authors.initials: G
authors.lastname: Wieselthaler
authors.forename: M
authors.initials: M
authors.lastname: Lanzenberger
authors.forename: R
authors.initials: R
authors.lastname: Ullrich
authors.forename: G
authors.initials: G
authors.lastname: Laufer
authors.forename: M
authors.initials: M
authors.lastname: Grimm
authors.forename: E
authors.initials: E
authors.lastname: Wolner
mesh_terms: D000328:Adult; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D016879:Salvage Therapy / Q000379:methods*; D017565:Sarcoidosis, Pulmonary / Q000601:surgery; D020123:Sirolimus / Q000627:therapeutic use*; D013995:Time; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus