Impact of immunosuppressive treatment on the cardiovascular system in patients after hand transplantation.
BACKGROUND
Cardiovascular disease is a major cause of mortality in solid organ allograft recipients. Hand transplantation is not a lifesaving procedure, thus the effect of long-term immunosuppression on the cardiovascular system in these patients should be monitored. The aim of this study was to evaluate the morphology and function of heart and blood vessels in patients after hand transplantation.


METHODS
The study included 5 patients at ages 32 to 58 years, mean 39 years, who underwent hand transplantation between 2006 and 2010. Immunosuppressive treatment included basiliximab in induction and tacrolimus, mycophenolate mofetil, and prednisone. Cardiac status was assessed by echocardiography (according to the American Society of Echocardiography) and cardiac biomarkers. Blood vessels were estimated by carotid intima-media thickness, pulse wave velocity, and brachial artery flow-mediated dilatation (FMD). The examinations were performed at 28 to 79 (mean 43) months after transplantation.


RESULTS
Cardiovascular risk factors were observed in all patients after transplantation: 2 had insulin-dependent diabetes, 3 developed dyslipidemia and hypertension, 2 had chronic kidney disease stage 3. Concentric left ventricular hypertrophy was found in 1 and ventricular concentric remodeling in 4 patients. Impaired diastolic function (E/e' > 8) was observed in 2 patients. The index volume of the left atrium was higher in all patients. The cardiac biomarkers N-terminal pro-brain natriuretic peptide, C-reactive protein, and troponins were within normal range. Carotid intima-media thickness was higher in 1 patient and normal in 4 patients. Arterial stiffness measured by pulse wave velocity was not increased in all patients. Native brachial artery FMD response, an index of endothelium-dependent function, was abnormal in 2 patients, but in the transplanted extremity FMD was abnormal in 4 patients.


CONCLUSIONS
Pathologic changes in cardiac structures were found in all patients, but the arterial wall changes and endothelial dysfunction were observed in some patients. Patients after hand transplantation are at higher risk for cardiovascular disease.
Department of Nephrology and Transplant Medicine, Wrocław Medical University, Wrocław, Poland. Electronic address: maria.boratynska@op.pl.
M
M
Boratyńska
Department of Cardiac Surgery, Wrocław Medical University, Wrocław, Poland.
M
M
Obremska
Department of Angiology and Hypertension, Wrocław Medical University, Wrocław, Poland.
R
R
Małecki
Department of Angiology and Hypertension, Wrocław Medical University, Wrocław, Poland.
M
M
Gacka
Department of Nephrology and Transplant Medicine, Wrocław Medical University, Wrocław, Poland.
M
M
Magott
Department of Nephrology and Transplant Medicine, Wrocław Medical University, Wrocław, Poland.
D
D
Kamińska
Department of Nephrology and Transplant Medicine, Wrocław Medical University, Wrocław, Poland.
M
M
Banasik
Department of Nephrology and Transplant Medicine, Wrocław Medical University, Wrocław, Poland.
M
M
Kusztal
Subdepartment of Limb Replantation, St. Hedvig Hospital, Trzebnica, Poland.
A
A
Chełmoński
Subdepartment of Limb Replantation, St. Hedvig Hospital, Trzebnica, Poland.
J
J
Jablecki
Department of Nephrology and Transplant Medicine, Wrocław Medical University, Wrocław, Poland.
M
M
Klinger
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D064595:Composite Tissue Allografts / Q000276:immunology; D005260:Female; D063987:Hand Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D063986:Vascularized Composite Allotransplantation / Q000009:adverse effects*; D020257:Ventricular Remodeling
D007166:Immunosuppressive Agents