心脏移植后16年行再次心脏移植一例

One case of heart retransplantation 16 years after primary heart transplantation

目的总结心脏移植术后16年成功进行再次心脏移植的体会。方法为1例首次心脏移植后存活16年继发严重冠状动脉病变和心功能衰竭的受者施行再次心脏移植。术中仔细分离首次移植心脏与周围严重粘连的组织，采用传统的Stanford吻合方法。手术前采用血浆置换和巴利昔单抗诱导治疗1次，术后采用环孢素A、吗替麦考酚酯和泼尼松的免疫抑制方案。结果手术顺利，术后早期并发急性肾功能衰竭、肺部感染、胸骨哆开和胸腔积液，经积极的对症治疗后痊愈出院。受者已存活1年余，出院后生活质量好，至今未发生急性排斥反应。结论再次心脏移植治疗首次移植心脏严重冠状动脉病变所致的慢性功能丧失可获得满意的近期疗效。首次移植心脏继发严重冠状动脉病变致心功能不全时宜尽早手术。对于严重的组织粘连，宜采用较为简单的传统Stanford吻合方法，避免术中广泛出血。根据受者的免疫功能和全身器官功能状况，应选择个体化的免疫抑制方案。

Objective To report the preliminary experience of the successful heart retransplantation in 1 patient i6 years after primary heart transplantation. Method Heart reptransplantation was performed on 1 patient with severe coronary allograft vasculopathy and graft failure 16 years after primary heart transplantation. During the procedure, dense adhesion was carefully dissected and standard ＂ stanford＂ technique was applied. The plasmapheresis was used preoperatively because of the high level of PRA antibody. The patient received Basiliximab （Simulect） induction therapy, and baseline triple immunosuppressive regime with cyclosporine （CsA）, mycophenolate mofetil （MMF） and prednisolone （Pred）. Results The following complications occurred in the early postoperative period： acute renal failure, the pulmonary infection, the sternum dehiscence and pleural effusion. The patient survived 12 months and had good life quality. No acute rejection was found during the follow-up. Conclusion The early result of heart retransplantation for patient with severe coronary allograft vasculopathy and graft failure after primary transplantation was satisfied. The procedure should be performed as soon as possible when graft failure due to coronary allograft vasculopathy occurred. The standard ＂stanford＂ anastomosis technique was appropriate for dense adhesion. The individual immunosuppressive regime should be selected according to the assessment of immune function, liver function and renal function.