The diagnosis of acute rejection in heart allograft recipients receiving cyclosporine is still an important challenge. The poor diagnostic value of clinical signs and the ECG means that regular endomyocardial biopsies must be performed. Despite their diagnostic value during the first year after transplantation, endomyocardial biopsies are less sensitive there after and currently suffer from the lack of a universally accepted histological classification. Doppler echocardiography can be used for routine surveillance and has proven reliable for the diagnosis of acute rejection with various clinical presentations when used in conjunction with endomyocardial biopsies. Immunohistological examination of myocardial specimens can further increase the sensitivity of histological diagnosis. Similarly, immunoscintigraphy with indium 111-labelled antimyosin antibodies is of value for the prediction of acute rejection after the first year. Therapeutic approaches have been standardized, but must still be tailored to the individual patient according to the severity of the rejection and the presence of associated infection and/or metabolic disturbances.

Acute Disease↗

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[Renal function and arterial pressure in 22 heart transplant recipients treated with cyclosporin for more than 5 years].

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Adolescent↗

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Renal function and blood pressure in heart transplant recipients treated with cyclosporine.

Cyclosporine, a cyclic endecapeptide of fungal origin, has been used for nine years in clinical transplantation to suppress allograft rejection. Nephrotoxicity represents the most frequent and severe complication associated with its use and may ultimately define the limits of its utility as a drug for long term immunosuppression. However, this nephrotoxicity cannot be truly assessed in kidney transplant recipients for obvious reasons. It has recently been reported in heart transplant recipients. In addition, cyclosporine therapy is responsible for a persistent elevation of blood pressure requiring intensive and combined anti-hypertensive regimens. This hypertension develops within the first weeks post-transplantation in 60% to 90% of heart allograft recipients. This study analyzes the renal function and blood pressure of patients operated on in our department where cyclosporine was introduced in 1981.

Actuarial Analysis↗

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