Cardiac Transplantation

Immunosuppressive Therapy After Cardiac Transplantation (Treatment Strategies in Cardiac Transplantation) Part 1

Introduction In contrast to renal or pancreas transplantation graft failure after heart transplantation (HTx) is associated with the death of the patient if re-grafting or mechanical support (MCS) is not possible immediately. Since the beginning of modern transplantation medicine one of the highest priorities were preventing and treating graft rejection. Over the last decades experimental, […]

Immunosuppressive Therapy After Cardiac Transplantation (Treatment Strategies in Cardiac Transplantation) Part 2

Enteric-coated Mycophenolate sodium Enteric-coated Mycophenolate sodiumfortic (EC-MPS) is an enterie formulation of mycophenolate sodium (a prodrug of MPA). MPA reversible inhibits the inosine monophosphate dehydrogenase and the pathway of guanosine nucleotide synthesis which affects B and T lymphocytes whereas other cell types can utilize salvage pathyways for purine synthesis. The coating of mycophenolate sodium should […]

Antibody Mediated Rejection of the Cardiac Allograft (Treatment Strategies in Cardiac Transplantation) Part 1

Introduction Antibody mediated rejection (AMR), also known as B-cell mediated rejection or humoral rejection, of the cardiac allograft was first clinically described in the late 1980′s (Herskowitz et al., 1987) followed shortly thereafter by pathologic evidence to support a unique rejection process apart from cellular mechanisms (Hammond et al., 1989). This is in contrast to […]

Antibody Mediated Rejection of the Cardiac Allograft (Treatment Strategies in Cardiac Transplantation) Part 2

Plasmapheresis techniques Three main techniques can be utilized: therapeutic plasma exchange (TPE), double-filtration plasmapheresis (DFPP), and immunoadsorption plasmapheresis (IAPP). Therapeutic plasma exchange involves separation of red blood cells from plasma, complete removal of all plasma, and finally administration of exogenous fresh-frozen plasma or albumin to replace the plasma removed. In many centers, protocols require repletion […]

Nutritional Intervention in Heart Transplant Recipients – Dietary Recommendations (Treatment Strategies in Cardiac Transplantation) Part 1

Introduction Timely nutrition assessment and intervention in organ transplant recipients may improve outcomes surrounding transplantation. Because nutritional status is a potentially modifiable risk factor, the development of strategies designed to optimize nutritional status decreases the short-term risks in the post transplant period (Russo et al., 2010). Despite many advances in surgical techniques, diagnostic approaches and […]

Nutritional Intervention in Heart Transplant Recipients – Dietary Recommendations (Treatment Strategies in Cardiac Transplantation) Part 2

Dyslipidemia Dyslipidemia is common after cardiac transplantation. Multiple factors in transplant recipients promote dyslipemia: inappropriate diet in combination with reduced physical activity, immunosuppression with cyclosporine and steroids, anti-hypertensive agents and concomitant conditions, such as diabetes, obesity, age and male gender. Total and low-density lipoprotein (LDL) cholesterol are prominent risk factors for major progression of CAV […]

Physical Rehabilitation (Treatment Strategies in Cardiac Transplantation) Part 1

Introduction Heart transplantation is the ultimate therapy for patients in the end stage of heart failure in order to either restore or promote patients a better functional performance (Bocchi, 2001; Guimaraes, 1999). The first heart transplant in the world was performed in 1967 and the procedure has been even more present in this area since […]

Physical Rehabilitation (Treatment Strategies in Cardiac Transplantation) Part 2

Exercise program in heart transplanted patients Regular physical activity has played important role in the improvement of quality, as demonstrated in studies because regular physical activity may revert or diminish the physiological alterations in transplanted patients (Fig.9 ) (Guimaraes, 2004). Fig. 9. Association between physical capacity and heart transplantation and the potential role of physical […]

Physical Rehabilitation (Treatment Strategies in Cardiac Transplantation) Part 3

Flexibility exercises Stretching exercises should be conducted to promote gains on range of motion, balance, to stretch the muscles of the neck, lower back, upper and lower limbs. Exercise with elastic can be performed in small series of ten repetitions for each muscle prioritizing posterior trunk and involving large joints of hip, knee, elbow and […]

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients (Chronic Rejection in Cardiac Transplantation) Part 1

Introduction Cardiac allograft vasculopathy (CAV) represents the most common cause of late graft failure and limits the long-term success of heart transplantation. It is the most common cause of death, in addition to malignancy, in patients who survive the first year after transplant (Taylor et al., 2006). CAV is a diffuse, accelerated form of coronary […]

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