Lymphomas following cardiac transplantation. Case report and review of the literature

Infections in solid-organ transplant recipients

Solid-organ transplantation is a therapeutic option for many human diseases. Infections are a major complication of solid-organ transplantation. All candidates should undergo a thorough infectious-disease screening prior to transplantation. There are three time frames, influenced by surgical factors, the level of immunosuppression, and environmental exposures, during which infections of specific types most frequently occur posttransplantation. Most infections during the first month are related to surgical complications. Opportunistic infections typically occur from the second to the sixth month. During the late posttransplant period (beyond 6 months), transplantation recipients suffer from the same infections seen in the general community. Opportunistic bacterial infections seen in transplant recipients include those caused by Legionella spp., Nocardia spp., Salmonella spp., and Listeria monocytogenes. Cytomegalovirus is the most common cause of viral infections. Herpes simplex virus, varicella-zoster virus, Epstein-Barr virus and others are also significant pathogens. Fungal infections, caused by both yeasts and mycelial fungi, are associated with the highest mortality rates. Mycobacterial, pneumocystis, and parasitic diseases may also occur.

Acute leukaemia following renal transplantation

Four renal transplant patients on immunosuppressive therapy who presented with acute myeloid leukaemia are described. In two cases, azathioprine may have played an important role as a cofactor in leukaemogenesis. In a third case, the alkylating agent cyclophosphamide may have contributed. All patients were treated for leukaemia with full doses of cytotoxic chemotherapy and, in each case, a functioning renal allograft was preserved throughout the treatment despite attenuation of immunosuppressive therapy. Three patients achieved complete remission. Of the three, one is surviving at 2 years and two expired during the pancytopenic phase of their treatment with no active leukaemia present, and with intact renal function. As increasing expertise in the field of organ transplantation allows patients to survive longer, such patients' exposure to immunosuppressive and potentially leukaemogenic drugs is prolonged. The risk of secondary neoplasia has been previously documented in this population. Two of the four cases reported here suffered from polycystic kidney disease as their underlying condition. While this report suggests that the leukaemias are related to renal transplantation, we cannot rule out an association with the underlying disease which led to the transplant. This report further suggests that the leukaemia that develops in such patients may respond to standard therapy, and that such treatment does not compromise the transplanted kidney.

Cardiac transplantation: a review for critical care nurses

Advances in immunology, immunosuppressive therapy, and preservation techniques have contributed to making cardiac transplantation an accepted therapy for end-stage heart disease. One-year survival rates now exceed 90% at some transplant centers. However, serious complications, such as infection, rejection, coronary artery disease, and malignancies, continue to plague long-term survival rates in this patient population. Balancing the immune system between infection and rejection requires the special expertise of experienced cardiologists and immunologists. An improved understanding of the immune system promises to increase long-term survival rates of cardiac transplant recipients. Critical care nurses require special assessment skills to meet the demanding challenges of cardiac transplant recipients in the immediate postoperative period. The impact of cardiac denervation, immunosuppression, and the risk for acute rejection add a different perspective for nursing interventions in the critical care environment. With mortality rates remaining at 8 to 10% for the first month following cardiac transplantation, the skill of critical care nurses is crucial to decreasing morbidity and increasing survival during the acute perioperative period.

Primary bronchogenic carcinoma in the heart transplant recipient

An increased risk of neoplasia is a well-recognized complication of chronic immunosuppression. Although lung cancer has been sporadically reported in the transplant population, it has not been recognized widely as a specific risk among heart transplant recipients. We present 3 cases of bronchogenic carcinoma in cardiac transplant patients, discuss possible risk factors, and outline recommendations for diagnosis and management of new lung lesions discovered during routine follow-up.