Staged approach to mechanical circulatory support and recovered allograft function after transplantation rejection with cardiogenic shock.

Cardiogenic shock resulting from acute rejection after heart transplantation is an infrequent but life-threatening condition. Intensified immunosuppressive therapy and the timely initiation of properly selected mechanical circulatory support can be life-saving and enable recovery of graft function. The few published reports on mechanical circulatory support for acute transplantation rejection have focused on short-term devices. We present the case of a 48-year-old woman who developed cardiogenic shock due to severe allograft rejection after heart transplantation. She underwent staged mechanical circulatory support: extracorporeal membrane oxygenation for 10 days and then biventricular assist device support for 5 weeks. Allograft function recovered completely, and this enabled removal of the assist device. The patient was alive 18 months after biventricular assist device insertion. To our knowledge, this is the first description of a successful staged approach involving short- and long-term mechanical circulatory support to resolve allograft rejection and refractory cardiogenic shock after heart transplantation.