[CIS-PAGID] Heart Tranplant in CVID

[Richard Wasserman]

I had an adult XLA patient who received a liver transplant about 20 years
ago for hepatitis C and chronic liver failure. It was difficult to convince
the transplant group to do him. Because of the pre-existing use of IgG
replacement it obviated the discussion of IgG therapy post-transplant and my
patient did very well for more than 15 years post-transplant until he
developed chronic rejection. He did have a fungal brain abscess but I think
that was immunosuppression for the transplant and not his pre-existing PID.
I suspect that your patient has few options.
Richard Wasserman
Dallas

On Wed, Apr 27, 2011 at 1:36 PM, Riedl, Marc <MRiedl at mednet.ucla.edu> wrote:


>  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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-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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