Question

A 23-year-old homeless male with a strong history of IV Methamphetamine abuse presents to the emergency department after being found unconscious outside of a local community college. He was found by a group of students lying in a pool of his own vomit, with a large needle in the right arm. The ambulance was immediately called, and he was given naloxone (Narcan) On route to the emergency department, which was unsuccessful in resuscitating him.  

Upon arrival, the patient’s blood pressure was found to be 70/40, and his heart rate was found to 184; his oxygen saturations were in the 70s despite high flow oxygen via nasal cannula. Upon arrival to the emergency department, it was noted that the patient lacked a pulse in his right radial artery, And so ACLS protocols were initiated. After about 10 minutes of CPR, the patient was successfully resuscitated and transported to the intensive care unit.

Upon being transferred to the intensive care unit, it was found that the patient had an ejection fraction of 10% on echocardiography. Cardiothoracic surgery was consulted, and it became immediately clear that this patient would require a heart transplant immediately.

The patient’s family was consulted, and they immediately came to the hospital to confer with the cardiothoracic surgery team. Meanwhile, the patient was appropriately matched and serotyped, and a compatible match for a heart was found.

The following morning, the patient was taken to the operating room, and a heart transplant procedure was performed. The surgery itself was successful, though it did take approximately seven hours to complete.

Please answer the following questions:

• Given that he received his new heart from a cadaver, what type of transplant occurred in this situation?
• Post operatively, would this patient require immunosuppression? If so, what type of medications would be appropriate?
• What risks does this patient incur if he becomes noncompliant or stops taking his immunosuppressive medications as an outpatient?
• Given that he received this new heart from a cadaver, is there any risk for “graft versus host” disease? Why or why not?

Answer 1

Ans 1

Transplants performed between two subjects of the same species is known as allografts. Allografts can either be from a living body or from a cadaveric source.

Ans 2

Immunosuppression is the key to successful post transplantation outcomes. immunosuppression reduce the chance of both acute and chronic allograft rejection.

Basic immunosuppressive regimen includes calcineurin inhibitors , antiproliferative agents, and corticosteroids. Novel treatment developed including stem cell based therapies and phagosomes.

Ans 3

Stopping these medication will lead to acute rejection within days of weeks. Signs and symptoms of acute rejection ibcludes fever , delirium , malaise and pain

Ans 4

Graft vs host disease(GvHD) might occour after an allogenic graft transplantation.

In GvHD the donated peripheral blood stem cells view the recipent's body as foreign, and the donated cells attack the body.