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Human heart heals itself 10.5 years after heterotopic transplantation
The patient, now 16-years-old, has normal cardiac function and no additional complications resulting from transplant procedure.
The heart of a pediatric transplant recipient whose donor heart was implanted on top of her own heart has regained normal cardiac function.
According to study results published in The Lancet, the patient presented with signs of severe HF at 8-months-old and underwent a heterotropic cardiac transplantation at 11 months. In the years following the pediatric transplant procedure, the female patient developed respiratory problems and recurrent post-transplant lymphoproliferative disorder stemming from an Epstein-Barr virus that was resistant to several therapies. The patient eventually developed cancer from the cyclosporine and azathioprine she took for immunosuppression. As a result, she was treated periodically with therapies including chemotherapy and rituximab (Rituxan, Biogen Idec, Genetech).
The donor heart was removed without complication 10.5 years post-implantation. According to the researchers, the patient is currently in complete remission from her post-transplant lymphoproliferative disorder, and the cardiac function of her heart is normal more than three years after the removal of the donor heart.
The researchers said that their findings highlighted a number of important issues regarding pediatric heterotopic cardiac transplantation, myocardial recovery and the management of post-transplant lymphoproliferative disorder.
“The late recovery of function in idiopathic cardiomyopathy might occur many years after the initial presentation, and in this situation, the removal of a heterotopic transplant is technically feasible,” the researchers wrote in the study. “A difficult balance needs to be achieved in patients who develop post-transplant lymphoproliferative disorder between sufficient reduction of immunosuppression to control post-transplant lymphoproliferative disorder, while maintaining enough immunosupression to prevent rejection, and that even low-dose immunosuppression might prevent the function of Epstein-Barr virus-specific T-cells in vivo, a finding which has important implications for adoptive immunotherapy for post-transplant lymphoproliferative disorder.” – by Eric Raible
Tsang V. Lancet. 2009;doi:10.1016/S0140-6736(09)61201-0.
The procedure is remarkable for at least three reasons: the use of a smaller heterotopic transplant heart as a piggyback support for a larger failing heart (we would probably use an LVAD for that today); the removal of that transplant to be able to stop the immunosuppressive therapy causing the post-transplant lymphoproliferative disorder associated with Epstein-Barr virus; and the reverse remodeling of the failing heart when unloaded and given a period of time to recover. Of these, the latter to me is most significant because it shows that the heart has reparative powers under certain circumstances. If we understood that mechanism, we might be able to capture it as therapy for other cardiac disorders.
Cardiology Today Section Editor