[CIS-PAGID] Heart Tranplant in CVID

[Jack Bleesing]

Thinking outside the box, perhaps it offers an opportunity to fix things permanently.

Thus, imagine, replacing his bone marrow some time after his heart transplant (within the first year). His new immune system would likely not know that his heart isn't his and be tolerant to it, such that no life-long rejection drugs are needed.

This is how it works in OLT and likely after renal transplant as well. Don't know about heart, but...

so CVID is not a barrier, but maybe an opportunity.

J

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Jack J.H. Bleesing, M.D., Ph.D.
Associate Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Division of Bone Marrow Transplantation & Immune Deficiency
3333 Burnet Avenue, MLC 7015
Cincinnati, OH 45229
513-636-4266 (phone)
513-636-3549 (fax)
Jack.Bleesing at CCHMC.org
http://www.cincinnatichildrens.org/immunodeficiencies/

>>> "Jason W. Caldwell"  04/27/11 2:18 PM >>>

<!--/* Font Definitions */@font-face{font-family:"Cambria Math";panose-1:2 4 5 3 5 4 6 3 2 4;}@font-face{font-family:Calibri;panose-1:2 15 5 2 2 2 4 3 2 4;}/* Style Definitions */p.MsoNormal, li.MsoNormal, div.MsoNormal{margin:0in;margin-bottom:.0001pt;font-size:11.0pt;font-family:"Calibri","sans-serif";}a:link, span.MsoHyperlink{mso-style-priority:99;color:blue;text-decoration:underline;}a:visited, span.MsoHyperlinkFollowed{mso-style-priority:99;color:purple;text-decoration:underline;}span.EmailStyle17{mso-style-type:personal-compose;font-family:"Calibri","sans-serif";color:windowtext;}.MsoChpDefault{mso-style-type:export-only;}@page WordSection1{size:8.5in 11.0in;margin:1.0in 1.0in 1.0in 1.0in;}div.WordSection1{page:WordSection1;}-->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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