Rejection

Posted By  CCF CARDIO MD-APS on January 19, 1998 at 17:15:20:

In Reply to: Rejection posted by Traci on January 07, 1998 at 00:12:20:

: Three months following heart transplant my father experienced a rejection.  He
  was treated with OKT3 in hope that it would reverse the effects of the rejection but
  it did not help.  Due to the severity of the rejection it is being considered
  that he could have suffered a silent heart attack along with the rejection.  Is this common?
  Could the OKT3 have done damage if there was indeed a silent heart attack?  Do silent heart
  attacks usually go unnoticed for some time.  Also, we have been told that after having
  gone through all of this it would be expected that the patient would go into shock for quite
  some time, my father was up and walking around until IV's strapped him in sort of speak.  Now he is
  filling with fluid, more than 30 lbs of fluid weight.  An ultrasound recently
  revealed that his kidneys are functioning, however he is not passing this
  fluid.  High dosages of Lacex haven't worked, nor Debutamine.  What causes this?

[CCF CARDIO MD APS]

_
Dear Traci,
    Rejection of a transplanted heart encompasses two forms of rejection, both which lead to failure of the heart.  A silent heart attack by definition goes unnoticed for a certain length of time and
presumably the heart attack occurred secondary to the rejection that occurred within the coronary arteries of the transplanted heart-a diffuse process that eventually leads to a diffuse occlussion of
the arteries or obliteration of blood flow to the cardiac muscle.  The other form of rejection involves attacks on the muscle tissue itself causing heart muscle weakness and heart failure- this is why
the patient "builds up fluid."  In general terms rejection severity predicts graft survival, such that as the rejection worsens the heart transplant fails, a very disappointing outcome but at this point
in medicine unavoidable.  There is no way to predict which transplant patients will reject more aggressively than others and even which patient's immune systems will respond to immunosuppressive agents
such as OKT3.  It would be important for you and your father to discuss specifically with the transplant physician what the prognosis is - given the signs and symptoms you described.
    Information provided in the Heart Forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).