Takada Takuma, Hattori Hidetoshi, Kikuchi Noriko, Ichihara Yuki, Saito Satoshi, Endo Natsumi, Iguchi Shigekazu, Yoshida Atsushi, Kikuchi Ken, Niinami Hiroshi, Hagiwara Nobuhisa, Nunoda Shinichi
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
J Cardiol Cases. 2020 Oct 22;23(2):83-86. doi: 10.1016/j.jccase.2020.09.010. eCollection 2021 Feb.
Heart transplantation improves quality of life and survival in patients with advanced heart failure. However, the shortage of available heart donors and technological advances for left ventricular assist devices (LVAD) have led to longer waiting times for transplantation, and long-term use of LVAD may increase the medical complexity of subsequent transplantation. We present the case of a 35-year-old man who underwent heart transplantation after being supported by an LVAD for 1490 days (∼4 years). He was sensitized with kidney dysfunction and recurrent infections, including candidemia, at the time of transplantation. He underwent a successful heart transplantation with pretransplant plasma exchange, intravenous immunoglobulin administration, early initiation of everolimus, and prompt management of infections. < With a growing number of heart transplant candidates who are supported by left ventricular assist devices for long duration, managing such candidates is becoming increasingly complex and difficult to standardize. The present case had three problems that were linked to each other: (1) anti-HLA antibodies, (2) fungal infection, and (3) pre-transplantation renal dysfunction. Management of heart transplant candidates, including desensitization and immunosuppressive therapies, should be tailored to the individual and the clinical presentation to improve the survival and quality of life.>.
心脏移植可改善晚期心力衰竭患者的生活质量并提高其生存率。然而，可用心脏供体的短缺以及左心室辅助装置（LVAD）技术的进步导致移植等待时间延长，长期使用LVAD可能会增加后续移植的医疗复杂性。我们报告了一例35岁男性患者的病例，该患者在接受LVAD支持1490天（约4年）后接受了心脏移植。移植时，他因肾功能不全和包括念珠菌血症在内的反复感染而致敏。他通过移植前血浆置换、静脉注射免疫球蛋白、早期开始使用依维莫司以及及时处理感染，成功接受了心脏移植。<随着越来越多的心脏移植候选者长期接受左心室辅助装置的支持，管理这些候选者变得越来越复杂且难以标准化。本病例存在三个相互关联的问题：（1）抗HLA抗体，（2）真菌感染，以及（3）移植前肾功能不全。对心脏移植候选者的管理，包括脱敏和免疫抑制治疗，应根据个体情况和临床表现进行调整，以提高生存率和生活质量。>
