title: Staged approach to mechanical circulatory support and recovered allograft function after transplantation rejection with cardiogenic shock.
abstract: Cardiogenic shock resulting from acute rejection after heart transplantation is an infrequent but life-threatening condition. Intensified immunosuppressive therapy and the timely initiation of properly selected mechanical circulatory support can be life-saving and enable recovery of graft function. The few published reports on mechanical circulatory support for acute transplantation rejection have focused on short-term devices. We present the case of a 48-year-old woman who developed cardiogenic shock due to severe allograft rejection after heart transplantation. She underwent staged mechanical circulatory support: extracorporeal membrane oxygenation for 10 days and then biventricular assist device support for 5 weeks. Allograft function recovered completely, and this enabled removal of the assist device. The patient was alive 18 months after biventricular assist device insertion. To our knowledge, this is the first description of a successful staged approach involving short- and long-term mechanical circulatory support to resolve allograft rejection and refractory cardiogenic shock after heart transplantation.
authors.affiliation: Divisions of Cardiothoracic Surgery (Drs. Caceres, Esmailian, and Ramzy) and Cardiology (Drs. Czer and Moriguchi), Cedars-Sinai Heart Institute; and Department of Pathology (Dr. Luthringer), Cedars-Sinai Medical Center; Los Angeles, California 90048.
authors.forename: Manuel
authors.initials: M
authors.lastname: Caceres
authors.affiliation: Divisions of Cardiothoracic Surgery (Drs. Caceres, Esmailian, and Ramzy) and Cardiology (Drs. Czer and Moriguchi), Cedars-Sinai Heart Institute; and Department of Pathology (Dr. Luthringer), Cedars-Sinai Medical Center; Los Angeles, California 90048.
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Divisions of Cardiothoracic Surgery (Drs. Caceres, Esmailian, and Ramzy) and Cardiology (Drs. Czer and Moriguchi), Cedars-Sinai Heart Institute; and Department of Pathology (Dr. Luthringer), Cedars-Sinai Medical Center; Los Angeles, California 90048.
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Divisions of Cardiothoracic Surgery (Drs. Caceres, Esmailian, and Ramzy) and Cardiology (Drs. Czer and Moriguchi), Cedars-Sinai Heart Institute; and Department of Pathology (Dr. Luthringer), Cedars-Sinai Medical Center; Los Angeles, California 90048.
authors.forename: Daniel
authors.initials: D
authors.lastname: Luthringer
authors.affiliation: Divisions of Cardiothoracic Surgery (Drs. Caceres, Esmailian, and Ramzy) and Cardiology (Drs. Czer and Moriguchi), Cedars-Sinai Heart Institute; and Department of Pathology (Dr. Luthringer), Cedars-Sinai Medical Center; Los Angeles, California 90048.
authors.forename: Danny
authors.initials: D
authors.lastname: Ramzy
authors.affiliation: Divisions of Cardiothoracic Surgery (Drs. Caceres, Esmailian, and Ramzy) and Cardiology (Drs. Czer and Moriguchi), Cedars-Sinai Heart Institute; and Department of Pathology (Dr. Luthringer), Cedars-Sinai Medical Center; Los Angeles, California 90048.
authors.forename: Jaime
authors.initials: J
authors.lastname: Moriguchi
mesh_terms: D064591:Allografts / Q000502:physiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications* / Q000628:therapy; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Device removal; graft rejection/etiology/pathology/prevention & control; heart transplantation/adverse effects/instrumentation; heart-assist devices; postoperative complications/etiology; recovery of function/physiology; shock, cardiogenic/etiology/therapy; time factors; treatment outcome; ventricular dysfunction/complications