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Early primary graft failure after a pediatric heart transplant and successful rescue with plasmapheresis, immunoglobulins, and alemtuzumab


1 Department of Pediatrics, Division of Pediatric Cardiology, Holtz Children's Hospital/Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
2 Department of Surgery, Transplantation Laboratories, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA

Correspondence Address:
Shashi Raj
Department of Pediatrics, Division of Pediatric Critical Care and Cardiology, University of Iowa Children's Hospital, 200 Hawkins Drive, JPP 7770-B, Iowa City, IA 52246
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.197063

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Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 69-71

 

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Early primary graft failure after pediatric orthotopic heart transplantation (OHT) has a high mortality rate and can occur due to several causes including but not limited to prolonged graft ischemia time, suboptimal preimplant myocardial preservation, hyperacute rejection, and maladaptation of the graft to the host's hemodynamic status. Mechanical circulatory support with either extracorporeal membrane oxygenation (ECMO) or ventricular assist device has been used for the rescue of primary graft failure in pediatric patients after heart transplant. Cardiac arrest before ECMO initiation in these patients is associated with adverse neurologic outcome although those surviving to hospital discharge generally have excellent long-term outcome. We report a case of early primary graft failure after OHT who required ECMO support and successful rescue with plasmapheresis, immunoglobulins, and alemtuzumab.






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1 Department of Pediatrics, Division of Pediatric Cardiology, Holtz Children's Hospital/Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
2 Department of Surgery, Transplantation Laboratories, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA

Correspondence Address:
Shashi Raj
Department of Pediatrics, Division of Pediatric Critical Care and Cardiology, University of Iowa Children's Hospital, 200 Hawkins Drive, JPP 7770-B, Iowa City, IA 52246
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.197063

Rights and Permissions

Early primary graft failure after pediatric orthotopic heart transplantation (OHT) has a high mortality rate and can occur due to several causes including but not limited to prolonged graft ischemia time, suboptimal preimplant myocardial preservation, hyperacute rejection, and maladaptation of the graft to the host's hemodynamic status. Mechanical circulatory support with either extracorporeal membrane oxygenation (ECMO) or ventricular assist device has been used for the rescue of primary graft failure in pediatric patients after heart transplant. Cardiac arrest before ECMO initiation in these patients is associated with adverse neurologic outcome although those surviving to hospital discharge generally have excellent long-term outcome. We report a case of early primary graft failure after OHT who required ECMO support and successful rescue with plasmapheresis, immunoglobulins, and alemtuzumab.






[FULL TEXT] [PDF]*


        
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