Psychiatric distress during stages of the heart transplant protocol.

Psychiatric observations are reported on 101 heart transplant candidates (40 of whom had transplantations). Emotional responses were recorded during the evaluation, during the waiting period, perioperatively, at biopsy, during rejection episodes, and before and after discharge. Those phenomena, with the exception of behavioral management problems, were unrelated to initial psychiatric diagnoses; the diagnoses often reflected emotional reaction to cardiac illness. Most distress after evaluation appeared to be related to the protocol rather than to preexisting psychopathology. The stage of the protocol affected the nature of the reactions. Psychiatric assistance aided the adjustment process.

Otolaryngologic problems in cardiac transplant patients.

Cardiac transplantation is now a well-accepted treatment for selected patients who have end-stage heart disease. Of the 38 patients who underwent cardiac transplants at our center from August 1984 through August 1987, 27 received consultation for otolaryngologic problems. Eleven patients had sinonasal complications; 8 had laryngotracheal complications; 4 had otologic complications; 2 had oropharyngeal complications; and 2 had a combination of more than one of the above complications. Of these otolaryngologic disorders, 63% were infectious in etiology. Development of otolaryngologic infections generally did not correlate with either higher doses of maintenance immunosuppression or with treatment of an acute rejection episode, which requires increased immunosuppression. Otolaryngologists should be aware of the sinonasal, laryngotracheal, oropharyngeal, and otologic disorders that can occur in cardiac transplant patients.