Management of Hemorrhage and Heart Transplant in Non-cardiac Surgery

Abstract In this case series we discuss two patients status post cardiac transplant undergoing elective abdominal aortic aneurysm repair and discuss the management of anti-rejection medication in the setting of blood loss and transfusion. It is rare for patients with heart transplants to require surgery with expected large volume resuscitation. Implications of large volume resuscitation extend beyond the immediate perioperative period. The first case experienced an acute rejection episode and the second case did not. Serum levels of anti-rejection agents were monitored during the hemorrhage and in the post-operative period. Pulse dose methylprednisolone was employed in the second case and continued in the early postoperative period. This appeared to be effective as an adjunct immunosuppressant until antirejection medications reach therapeutic titers.