Cardiac transplantation in a patient with septicemia after prolonged intraaortic balloon pump support: implications for staged transplantation.

After initial support with an intraaortic balloon pump, and since the introduction of cyclosporine for immunosuppression, five patients have undergone cardiac transplantation in our institution with good results. Not one of these patients died of sepsis in the immediate postoperative period. We report the clinical course of one such patient to show the advantage of cyclosporine immunosuppression and the value of circulatory support devices in patients awaiting suitable cardiac donors. A 22-year-old mother of two children was transferred to our institution with progressive cardiac failure. An intraaortic balloon (IABP) was inserted after she had become hypotensive, obtunded and acidotic, with severe congestive heart failure. However, she failed to improve and we performed a cardiac transplantation. After major problems with infections-a leading cause of death among cardiac transplant recipients-and episodes of convulsions that were controlled with Dilantin, along with other complications, she slowly but progressively improved and was discharged 7 weeks post-transplantation. She had one episode of allograft rejection, which was reversed with a short course of Solu Medrol. She is alive and well 18 months post-transplantation. In conclusion, cardiac transplantation in patients with sepsis can be expected to have a favorable outcome if cyclosporine is used for immunosuppression. When IABP or any other circulatory assist device is used as a bridge to cardiac transplantation, it is still possible to control infection in such patients, especially when cyclosporine is used as the major immunosuppressive.