Hyperacute graft rejection during heart transplantation for giant cell myocarditis: a case report.
We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had received abundant transfusions that had raised her anti-HLA antibody titers. The cross-match test was positive. No pre-transplantation immunosuppressive therapy had been administered given concomitant infection. The severity and acuteness of the rejection in this case likely reflect the combined effect of preformed anti-HLA antibodies in the context of an active organ-specific immune process at the time of transplantation. This case raises the questions of the need for intensive immunosuppressive therapy before transplantation in giant cell myocarditis and of the management of patients with positive cross-match in the context of a giant cell myocarditis.
Mutijima
Eugene
E
Department of Pathology, CHU Sart-Tilman, University of Liège, Belgium.
Delbecque
Katty
K
Defraigne
Jean-Olivier
JO
Bouillenne
Claire
C
Damas
Pierre
P
Pierard
Luc
L
Boniver
Jacques
J
de Leval
Laurence
L
D000208:Acute Disease; D000906:Antibodies / Q000097:blood / Q000276:immunology; D001788:Blood Grouping and Crossmatching; D017809:Fatal Outcome; D005260:Female; D015726:Giant Cells / Q000473:pathology; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D009205:Myocarditis / Q000601:surgery
D000906:Antibodies; D006680:HLA Antigens