Atalay METE, Ömer BAYEZİD, İlhan GÖLBAŞI, Ozan ERBASAN, Harun GÜLMEZ, Aytül BELGİ, Volkan YURTMAN, Mehmet KABUKÇU, Cengiz TÜRKAY

Ortotopik kalp transplantasyonu sonrasında gelişen komplikasyonlar

Amaç: Kalp transplantasyonu, kalp yetmezliğinde rutin bir tedavi yöntemi olarak birçok merkez tarafından uygulanmaktadır. Ancak, bu merkezlerde uygulamalardaki farklılıklar nedeniyle transplantasyon sonrası değişik komplikasyon oranları bildirilmektedir. Bu yazımızda, kliniğimizde uygulanan ortotopik kalp transplantasyonu sonrası gelişen komplikasyonlarımızı gözden geçirmeyi amaçlandık. Materyal ve Metod: Ağustos 1998 ve Haziran 2002 tarihleri arasında toplam 8 hastaya ortotopik kalp transplantasyonu yapıldı. Hastalarımızın 7'si erkek, 1'i kadın olup, yaş ortalamaları 47 ± 10 yıl (30-60) idi. Etiyolojide hastalarımızın üçünde iskemik kardiyomiyopati (%37), beşinde idiyopatik dilate kardiyomiyopati (%63) mevcut idi. Tüm hastalarımızda üçlü immunsüpressif tedavi (siklosporin A, azatioprin ve prednizolon) uygulandı. Rejeksiyon takibinde endomiyokardiyal biyopsi (EMB) kullanıldı. Koroner allogreft vaskülopati takibi için her yıl koroner anjiyografi yapıldı. Bulgular: Transplantasyon sonrası iki hastada hipertansiyon, iki hastada diyabet ve bir hastada lenfoma gelişti. Rejeksiyon takibi için toplam 59 EMB yapıldı ve 34 biyopsi Grade (G) 0, 14 biyopside GI, 8 biyopside GII, 3 biyopside GIII akut rejeksiyon bulguları saptandı. Bir hastamız geç dönemde fulminan hepatit nedeniyle kaybedildi. Sonuç: Kalp transplantasyonu sonrası bir çok komplikasyon gelişmektedir. Bu komplikasyonlar etkili takip ve tedavi edildikleri takdirde, transplantasyon sonrası yaşam süresi ve kalitesinde önemli artış sağlanabileceğini düşünmekteyiz.

Complications after orthotopic heart transplantation

Background: Heart transplantation is performed as a routine treatment method for heart failure in many centers. However, various complication rates have been reported mainly due to differences in some aspects of practises in these centers. In the present study we reviewed the complications after orthotopic heart transplantation procedures performed in our clinic. Methods: A total of 8 orthotopic heart transplantations were performed between August 1998, and June 2002. The mean age of the patients (7 male and 1 female) was 47 ± 10 years (ranged; 30 to 60 years). Two subgroups of patients were defined on the basis of etiology: first group included 3 patients with ischemic cardiomyopathy (37%), and the second, 5 patients with idiopathic dilated cardiomyopathy (63%). All patients received triple immunsupressive treatment with cyclosporine A, azathioprine and prednisolone. Endomyocardial biopsy was used in follow-up of the rejection. Coronary angiography was performed for coronary allograft vasculopathy every year. Results: Following transplantation, we observed hypertension in two patients, diabetes mellitus in two patients and lymphoma in one patients. A total of 59 endomyocardial biopsies were performed for rejection researches. We observed 34 Grade (0), 14 Grade (1), 8 Grade (2) and 3 Grade (4) biopsies with acute rejections. One patient died in the late period due to fulminant hepatitis. Conclusions: A large variety of complications develope after cardiac transplantation. The effective evaluation and treatment of these complications might increase the survival and the life quality after cardiac transplantation.

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