The value of recipient heart assistance during severe acute rejection following heterotopic cardiac transplantation.

Acute rejection remains a major complication of cardiac transplantation. One of the advantages of heterotopic as opposed to orthotopic heart transplantation is that the recipient heart remains in situ, and may provide valuable support for the circulation if donor heart function is severely reduced during an acute rejection episode. Details are presented of 11 patients who underwent acute rejection severe enough to cause loss of significant function of the donor heart, during which time life was maintained by the patient's own diseased heart. In 5 cases the acute rejection proved reversible, with patient survival extending from 10 weeks to 61/2 years, though only 2 remain alive today. In 6 cases rejection was irreversible; 4 of these patients underwent a second heart transplant, but only 1 remains alive today.