Fever, Malaise, and Dyspnea in a Diabetic Heart Transplant Patient: A Case Report.

Patients with solid-organ transplants usually present at the emergency department with nonspecific symptoms. The physician should consider a great variety of syndromes and diseases, given the greater risk that solid-organ transplant patients carry because of immunosuppression and transplant-related conditions. Myocardial infarction caused by cardiac allograft vasculopathy must be always suspected and ruled out, even when initial symptoms do not orientate in that direction. We present a case that conjugates signs that can be present in different pathologies. It shows that fever is not always related to infection or rejection but could also appear in acute cardiac allograft vasculopathy. It emphasizes the need of a multi-disciplinary team led by a heart transplant specialist when dealing with this sort of clinical case.

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History.

Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immu-nosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.

Incidence and risk factors for nonmelanoma skin cancer after heart transplantation.

INTRODUCTION: The incidence of skin cancer in heart transplant (HT) patients is higher than in the general population, reversing the proportion of cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) with a predominance of the former. The etiologic role of new immunosuppressants is not well known. We sought to ascertain the incidence of SCC and BCC in HT patients and the risk factors for its occurrence. PATIENTS AND METHODS: We report the incidence of all types of post-HT skin cancer, SCC, and BCC among adult HT patients in Spain (4089 subjects) as well as the influence of gender, age at heart transplant, immunosuppression, and sunlight exposure. RESULTS: The incidence rates of SCC and BCC, per 1000 persons/year, were 8.5 and 5.2, respectively. Males had a higher risk of SCC but not BCC. Induction therapy increased the risk of SCC and BCC. The relative risk of mycophenolate mofetil (MMF) was 0.3 (0.2-0.6; P<.0005) and azathioprine (AZA) 1.8 (1.2-2.7; P<.0032) for SCC, whereas tacrolimus and cyclosporine showed no difference. The relative risk of BCC was not affected by any immunosuppressant. CONCLUSION: Age at transplantation>45 years, induction therapy use, and high sunshine zone were risk factors for both SCC and BCC. Different immunosuppressive agents have different risks of nonmelanoma skin cancer, as AZA increases the risk of SCC and MMF is a protective factor. The relative risk of BCC was not affected by any immunosuppressor.

N-terminal pro-brain natriuretic peptide as a potential non-invasive marker of cardiac transplantation rejection.

BACKGROUND: Transplantation is the main palliative treatment for patients with heart failure. Clinical signs of cardiac rejection can be very non-specific or even absent. Thus, successful management relies on early diagnosis, ideally before the onset of clinical features of cardiac dysfunction. Although endomyocardial biopsy (EMB) is the reference diagnostic method, several non-invasive methods have been proposed to reduce the number of EMB performed during the follow-up of the transplanted patient. The aim of the present work was to study the potential relationship between rejection and serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as cardiac troponin T (cTnT) in post-transplantation patients. METHODS: Twenty-three consecutive orthotopic heart transplantation recipients with a mean age of 51 years (range 22-66) were prospectively recruited from the cardiac transplantation programme at the Hospital Universitario Central de Asturias. Serum NT-proBNP and cTnT were measured during the follow-up of these patients (ranging from 9-13 months post-transplantation) and compared with the results of EMB. RESULTS: Serum NT-proBNP concentrations progressively decrease during the first year post-transplantation, reaching concentrations slightly higher than the reference values. NT-proBNP concentrations increase significantly in those patients with a rejection episode graded >or=3A on the basis of the EMB (P<0.001, Mann-Whitney U-test). No relation between cTnT and rejection was observed. CONCLUSIONS: The potential of NT-proBNP as a non-invasive marker of transplantation rejection shows promising results, since NT-proBNP concentrations increase whenever a significant rejection event takes place in the first year of follow-up.