[CIS-PAGID] Heart Tranplant in CVID

[Riedl, Marc]

We have had a few CVID patients who have undergone solid organ transplants, including 1 heart.  In my limited experience, they have not had any unusual complications specifically attributable to CVI, though clearly there is infectious concern given the necessary immunosuppressive regimens.   I agree this is not an absolute contraindication, though it's sometimes challenging to convince the transplant team and may affect the listing priority.

Best,

Marc

Marc Riedl, M.D., M.S.
Assistant Professor of Medicine
Section Head, Clinical Immunology and Allergy
UCLA - David Geffen School of Medicine
10833 Le Conte Ave, 37-131 CHS
Los Angeles, CA  90095-1680
Tel 310.206.4345  Fax 310.267.0090



From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Jason W. Caldwell
Sent: Wednesday, April 27, 2011 11:18 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Heart Tranplant in CVID

I have a 16 year old patient in the hospital that has long standing dilated cardiomyopathy since at least the age of 3.  He was diagnosed with CVID by one of my predecessors.  He was diagnosed in 2002.  He was on IVIG in the past, but it looks like he has not been replacement therapy in at least the last three years.  Currently he has an IgG of <200 mg/dl, normal IgA and IgM, and not responses to tetanus or diphtheria.  His T cell numbers are normal but his absolute B cells are 40 cell/mcL.  (He has had low A in the past).  I am waiting on responses to mitgens and antigens and memory B cells.  I have restarted him on replacement Ig. Unfortunately, he was also lost to follow up in the cardiology clinic.  He presented 10 days ago with progressive dilated cardiomyopathy, CHF, and pneumonia.  He has not done well will to this point.  Cardiology now wants to consider him for a heart transplant and I was asked if his CVID would preclude him from a transplant.

My feeling is that it would not be considered an absolute contraindication.  I have found several cases in the literature where solid organ transplant has been done in the setting of CVID.  One was even a heart/lung transplant secondary to complications of CVID.

Does anyone have any wisdom or experiences they could share about solid organ transplantation in the setting of CVID?  Does anyone feel strongly that a heart transplant in this young man not be done?  (Assuming he meets other transplant requirements including having more consistent care)

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