The contribution of acute allograft rejection to posttransplant mortality has decreased
over time primarily due to improvements in maintenance immunosuppression and in the
diagnosis and treatment of rejection.[1]Nevertheless, acute heart allograft rejection remains an important clinical problem.[2] In the setting of an acute allograft rejection, mechanical circulatory support has
been provided by a variety of devices, ranging from intra-aortic balloon pumps (IABP)
to extracorporeal membrane oxygenators (ECMO), left ventricular assist devices (LVADs)
and biventricular assist devices (BIVADs).[2] We present a 45-year-old patient with cardiogenic shock secondary to acute allograft
rejection after orthotopic heart transplantation. Patient continued to have poor hemodynamics
and low cardiac output despite being on high doses of inotropes and an aggressive
immunosuppression. Hence, a decision was made to support the hemodynamics with an
Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD).
Keywords
aortic valve & root - circulatory assist devices (IABP, LVAD, RVAD, BVAD, TAH) - transplantation
- heart
