title: Use of Impella 5L for acute allograft rejection postcardiac transplant.
abstract: The contribution of acute allograft rejection to posttransplant mortality has decreased over time primarily due to improvements in maintenance immunosuppression and in the diagnosis and treatment of rejection. Nevertheless, acute heart allograft rejection remains an important clinical problem.2 In the setting of an acute allograft rejection, mechanical circulatory support has been provided by a variety of devices, ranging from intra-aortic balloon pumps (IABP) to extracorporeal membrane oxygenators (ECMO), left ventricular assist devices (LVADs) and biventricular assist devices (BIVADs).2 We present a 45-year-old patient with cardiogenic shock secondary to acute allograft rejection after orthotopic heart transplantation. Patient continued to have poor hemodynamics and low cardiac output despite being on high doses of inotropes and an aggressive immunosuppression. Hence, a decision was made to support the hemodynamics with an Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD).
authors.affiliation: Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada. r_chandola@rediffmail.com
authors.forename: Rahul
authors.initials: R
authors.lastname: Chandola
authors.forename: Robert
authors.initials: R
authors.lastname: Cusimano
authors.forename: Mark
authors.initials: M
authors.lastname: Osten
authors.forename: Eric
authors.initials: E
authors.lastname: Horlick
mesh_terms: D000208:Acute Disease; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007166:Immunosuppressive Agents; D008875:Middle Aged; D011474:Prosthesis Design; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D007166:Immunosuppressive Agents