The pathology of heart and heart and lung transplantation - an update

Article Abstract:

The most common causes of death during in the first year after heart and heart and lung transplantation are due to the rejection of the implanted tissue by the immune system and the development of infections. Infections occur because the patient is treated with drugs that suppress the immune system as a means of preventing rejection. Rejection of the transplant can be monitored by microscopic examination of tissue. A grading system of tissue rejection has been devised for both heart and lung tissue based on the extent of infiltration by immune cells. This grading system determines how the patient should be treated to prevent rejection. Analysis of the degree of rejection of the lung is complicated if infection is present. A greater rate of infection occurs in heart and lung transplants than in transplants of heart tissue alone. The types of infections are varied and include mycobacteria, cytomegalovirus, herpes simplex virus, aspergillus, pneumococcus and toxoplasma. Often contents from the lungs are used to identify the microorganisms; treatment can be given accordingly. The major long-term complication of heart transplantation is coronary occlusive disease, in which the arteries of the heart become blocked. The cause of the blockage is not known. Another long-term complication is cardiomegaly, in which the muscle cells of the heart multiple, enlarging the heart. A long-term complication of lung transplantation is severe bronchiolitis, or inflammation of the bronchioles of the lung to the point where the lung can no longer function. Another long-term complication is the increased incidence of cancer which occurs because the recipient's immune system has been immunosuppressed. In heart transplantation patients, the most common cancers seen are squamous cell carcinomas and nonHodgkin's lymphoma. Patients who receive heart and lung transplants have an increased incidence of cancer of the lymphocytes, primarily B lymphocytes, which is thought to be related to the activation of Epstein-Barr virus and treatment with immunosuppressive agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lungs, Graft rejection, Immunosuppressive agents, Immunosuppression, Lung transplantation

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Management of cytomegalovirus antibody negative patients undergoing heart transplantation

Article Abstract:

Cytomegalovirus (CMV) is a significant cause of complications and mortality after solid organ transplantation. Primary infection with CMV is associated with more serious disease than reactivated viral infection. Viruses, such as CMV, can be transmitted in transfused blood or via the grafted organ. The routes of virus transmission are clearly defined; consequently, prevention of CMV transmission would aid the implementation of management protocols. Of 61 transplant candidates treated between 1985 and 1988, 23 patients undergoing heart transplantation and 1 patient undergoing heart-lung transplantation tested negative for CMV antibodies on the day of surgery. These patients were vulnerable to CMV infection. Sixteen of the CMV antibody-negative patients received CMV-negative grafts and CMV-negative blood and blood products during surgery and postoperatively. Of this group, 12 patients survived the postoperative period. Within three months after transplantation, none of the survivors developed CMV antibodies or symptoms of CMV infection. Six transplant patients received grafts from CMV antibody-positive donors; CMV specific hyperimmune globulin was administered to these patients, who subsequently developed CMV antibodies and mild symptoms of infection. However, none of the patients required treatment for CMV infection. The results of graft CMV antibody testing were equivocal for the remaining two patients, who did not receive CMV specific hyperimmune globulin. Unfortunately, both patients developed CMV antibodies and primary infection of greater severity than that experienced by the patients treated with hyperimmune globulin. One patient required treatment. (Later tests revealed that both grafts were CMV-positive.) CMV infection in transplant candidates can be avoided by the use CMV-negative blood and blood products, and CMV-negative organ donors. Prophylactic administration of hyperimmune globulin could improve recovery opportunities when the donor tests positive for CMV antibodies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Testing, Disease transmission, Viral antibodies, Cytomegaloviruses, Cytomegalovirus

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Effect of Towne live virus vaccine on cytomegalovirus disease after renal transplant

Article Abstract:

Cytomegalovirus infection can cause severe disease and even death in some patients, and in immunocompromised patients in particular. Over 50 percent of kidney transplant recipients being treated with drugs to suppress their immune systems (to protect against rejection of the donated organ) will develop cytomegalovirus infection. Most of these infections arise from cytomegalovirus-positive donor kidneys, while a few are community-acquired. An attenuated (modified or weakened) cytomegalovirus strain called Towne virus has been used to produce a vaccine against cytomegalovirus. A study of the efficacy of this vaccine in either preventing or limiting cytomegalovirus-induced disease was conducted in 237 kidney transplant patients. They were divided into four groups based on the pretransplant cytomegalovirus exposure of both the donors and the recipients. Those at the highest risk for cytomegalovirus disease were in the recipient-negative, donor-positive group (who were infected by the donor kidney), followed by the recipient-positive, donor-positive patients (who could have experienced reinfection from the donor organ or reactivation of their own virus). The incidence of infection or disease did not differ between patients treated with placebo and those treated with Towne virus vaccine, but the severity of disease was considerable less in vaccine recipients. There was a trend suggesting a greater likelihood of kidney transplant success in the vaccinated patients, compared with those who had received placebo, but this was not found to be statistically significant. As the existing therapies for treating and preventing cytomegalovirus disease in kidney transplant recipients are quite expensive, vaccination may prove to be a more cost-effective approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kidneys, Kidney transplantation, Immunotherapy

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