Heart-lung transplantation (one long-term survial case report)

Objective To summarize the heart-lung transplantation (HLT) experience. Methods One case of ventricular septal defect of congenital heart disease with Eisenmenger syndrome,a 27-year-old female, underwent HLT on March 23,2006. Postoperatively the patient received guardianship of a long close,and induction therapy is applied with monoclonal antibodies. Rejection was prevented with Tacrolimus (converted to cyclosporine A later), mycophenolate mofetil (MMF), corticosteroids.Infection was monitored and controlled. Results The patient survived after the operation. No severe infection or acute rejection occurred. The postoperative hospital stay was 109 days. The patient has been alive till now for 3 years and 1 month. One year and 7 months after operation, the patient terminate immunosuppressive therapy by herself, and 2 weeks later hypoxia and low-grade fever occurred. Heart color B type ultrasound, chest CT scan, and the fiberoptic bronchoscopy did not reveal rejection-specific changes. Forced expiratory volume in 1 second was 0. 54. The symptoms still occurred on the height of suspected lung transplant rejection. Methylprednisolone was administered (500 mg×3 days), and the patient received oral prednisone for one month. Cyclosporine A was adjusted to maintain through blood levels of 0. 1664-0. 3328 μmol/L (0. 2-0.4 mg/L) ,MMF dosage was adjusted from 0.5 to 1 g/day,and at the same time the anti-infective therapy was done. Two weeks later the symptoms disappeared. Two years after operation, lung biopsy by the fiberoptic bronchoscopy did not show bronchiolitis obliterans syndrome. Two years and 5 months after operation, coronary angiography indicated that there was no stenosis of coronary artery, and cardiac function was normal. Conclusion The success of HLT is based on human leukocyte antigen (HLA) matching, reasonable organ preservation, careful surgical procedures, strict preventive measures against infection and immunosuppressive management. Key words: Heart-lung transplantation; Eisenmenger complex; Graft rejection