Recurrent primary cardiac malignant fibrous histiocytoma following orthotopic heart transplantation.

Malignant fibrous histiocytoma (MFH) is an extremely rare primary cardiac tumor. We describe a young patient who underwent orthotopic heart transplantation for an unresectable right ventricular MFH and presented 7 years later with a local recurrence in the native right atrium. This was treated by complete resection of the right atrial tumor and adjuvant chemotherapy. This case represents the only reported long-term survival following cardiac transplantation for MFH and describes our management strategy for local recurrence in this patient.

Infections in the heart transplant recipient.

The overall incidence of infection after transplantation has decreased with improved immunosuppressive agents, increased knowledge and use of prophylaxis, and better detection and treatment of infection. Nevertheless, infection continues to be a major cause of morbidity and mortality in heart transplant recipients. The knowledgeable nurse in any setting who cares for a transplant recipient must be aware of the lifelong susceptibility to common and opportunistic infections. The transplant recipient and his or her family must also be aware of the risks of early opportunistic infection. Infection is a lifelong concern for all persons on immunosuppressant medications, and the individual must learn appropriate precautions to reduce this risk. Hand washing and avoidance of infected individuals are the most important self-care actions that the transplant patient should adopt. Recipients must also learn to monitor for subtle signs of infection. The nurse is responsible for teaching self-care to patients and family members. Ultimately, a team effort by the patient, family, nurses, and physicians can reduce the risk of infection in this vulnerable population.

The challenge of managing the care of older heart transplant recipients.

Age is perhaps the most controversial exclusion criterion for heart transplantation. One concern focuses on whether chronological or functional age is the better predictor of positive outcomes when considering heart transplantation for an elderly patient with end-stage heart disease. Another concern is related to the philosophical and ethical rationale for allocation of scarce resources to those near the end of a normal life expectancy. However, the number of people who are older than age 65 years and have received a donor heart has increased and will continue to due to aging of the people who received a transplant a decade ago, as well as the growing number of people who undergo heart transplantation after the age of 65. In either case, the nurse must be aware of age-related concerns in this vulnerable population.