Biliary disease in conjunction with heart transplantation was encountered in 13 of 33 patients: in the past history (three patients), at pretransplant evaluation (nine patients), and appearing de novo after transplantation (one patient). Four patients with asymptomatic cholelithiasis underwent transplantation: biliary complications requiring emergency and/or urgent surgery occurred in all, with two deaths. Potentially complicating factors included (1) untoward effects of steroids on tissue healing and infection and (2) interaction between liver dysfunction and/or external bile loss and cyclosporine metabolism. Therapeutic lessons learned from this experience involve (1) selection of monoclonal antibodies over methylprednisolone for rejection control, (2) return of drained bile to the gastrointestinal tract, and (3) careful cyclosporine level and dosage monitoring. Five candidates with asymptomatic cholelithiasis underwent elective pretransplant biliary surgery; despite their compromised heart function, all patients had an uncomplicated postoperative course. We conclude that asymptomatic biliary disease is frequent in transplant candidates, can lead to serious morbidity and/or mortality after transplantation, and ideally can and should be treated before transplantation.

Adult↗

PubMedDate not supplied

Vein graft arteriovenous fistula for long-term venous access in a heart transplant recipient lacking superficial veins: a case report.

Construction of a (radial artery) saphenous vein graft arteriovenous fistula for blood sampling after heart transplantation is presented as a solution to the problem of a patient with poor or sclerosed superficial arm veins. Satisfactory experience with one patient over a 12.5 month follow-up is presented.

Arteriovenous Shunt, Surgical↗

PubMedDate not supplied

Experience and early results following heart transplantation at the Humana Heart Institute.

Five elective and one emergency orthotopic heart transplantation were performed in six patients, 32 to 54 years of age. Postoperative complications included transient renal failure in four patients with need for dialysis in one, seizure in one, and herpes infections in four. Immunosuppression of the first three patients consisted of cyclosporine and prednisone. The last three received cyclosporine and azathioprine, with prednisone added later for control of rejection. All six patients are home and well.

Adolescent↗