Skip to main content

Immediate Postoperative Care and Maintenance Immunosuppressive Therapy

  • Chapter
The Transplantation and Replacement of Thoracic Organs

Abstract

The immediate postoperative care of a patient who has undergone heart transplantation, whether it be orthotopic or heterotopic, is similar to that of any patient who has undergone open heart surgery. Precautions need to be taken, however, to minimize the risk of infection. Maintenance immunosuppressive therapy is begun immediately before the operation and is continued afterwards.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Greeley, W.J., Leslie, J.B., Reves, J.G. and Watkins, W.D. (1986). Eicosanoids (prostaglandins) and the cardiovascular system. J. Cardiac Surg., 1, 357

    Article  CAS  Google Scholar 

  2. Fonger, J.D., Borkon, A.M., Baumgartner, W.A., Achulf, S.C., Augustine, S. and Reitz, B.A. (1986). Acute right heart failure following heart transplantation: improvement with prostaglandin El and right ventricular assist. J. Heart Transplant., 5, 317

    PubMed  CAS  Google Scholar 

  3. Armitage, J.M., Hardesty, R.L. and Griffith, B.P. (1987). Prostaglandin El: an effective treatment of right heart failure after orthotopic heart transplantation. J. Heart Transplant., 6, 348

    PubMed  CAS  Google Scholar 

  4. Ferreira, S.H. and Vane, J.R. (1967). Prostaglandins: their disappearance from and release into the circulation. Nature (London), 216, 868

    Article  CAS  Google Scholar 

  5. Gorman, R.R. (1980). Biochemical and pharmacological evaluation of thromboxane synthetase inhibitors. Adv. Prostaglandin Thromboxane Leukotriene Res., 6, 417

    CAS  Google Scholar 

  6. Mathe, A.A. (1977). Prostaglandins and the lung. In Ramwell, P.W. (ed.) The Prostaglandins. Vol. 3, p. 169 (New York: Plenum Press)

    Google Scholar 

  7. Bremner, W.F., Taylor, K.M., Baird, S., Thomson, J.E., Thomson, J.A., Ratcliffe, J.G., Lawrie, T.D.V. and Bain, W.H. (1978). Hypothalamo-pituitary-thyroid axis function during cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg., 75, 392

    PubMed  CAS  Google Scholar 

  8. Robuschi, G., Medici, D., Fesani, F., Barboso, G., Montermini, M., D’Amato, L., Gardini, E., Borciani, E., Dall’Aglio, E., Salvi, M., Gnudi, A. and Roti, E. (1986). Cardiopulmonary bypass: ’a low T4 and T3 syndrome‘ with blunted thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH). Hormone Res., 23, 151

    Article  PubMed  CAS  Google Scholar 

  9. Novitzky, D., Human, P.A. and Cooper, D.K.C. (1988). Inotropic effect of triiodothyronine (T3) following myocardial ischemia and cardiopulmonary bypass. 1. An experimental study in pigs. Ann. Thorac. Surg., 45, 50

    Article  PubMed  CAS  Google Scholar 

  10. Norman, D.J., Illingworth, D.R., Munson, J. and Hosenpud, J. (1988). Myolysis and acute renal failure in a heart-transplant recipient receiving lovastatin. (Letter) N. Engl. J. Med., 318, 46

    Article  PubMed  CAS  Google Scholar 

  11. East, C., Alivizatos, P.A., Grundy, S.M., Jones, P.H. and Farmer, J.A. (1988). Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation. (Letter) N. Engl. J. Med., 318, 47

    Article  PubMed  CAS  Google Scholar 

  12. Thompson, C.B., June, C.H., Sullivan, K.M. and Thomas, E.D. (1984). Association between cyclosporine neurotoxicity and hypomagnesaemia. Lancet, 2, 1116

    Article  PubMed  CAS  Google Scholar 

  13. Schmitz, N., Eulen, H.H. and Loffler, H. (1985). Hypomagnesaemia and cyclosporine toxicity (Letter). Lancet, 1, 103

    Google Scholar 

  14. Salaman, J.R. (ed.) (1981). Immunosuppressive Therapy. (Philadelphia; Lippincott)

    Google Scholar 

  15. Schwartz, R.S. (1968). Immunosuppressive drug therapy. In Rapaport, F.T. and Dausset, J. (eds.) Human Transplantation, p. 440 (New York: Grune and Stratton)

    Google Scholar 

  16. Santos, G.W. (1972). Chemical immunosuppression. In Najarian, J.S. and Simmons, R.L. (eds.) Transplantation, p. 206. (Philadephia; Lea and Febiger)

    Google Scholar 

  17. Bach, J.F. (1976). The pharmacological and immunological basis for the use of immunosuppressive drugs. Drugs, 11, 1

    Article  PubMed  CAS  Google Scholar 

  18. Hurd, E.R. (1977). Drugs affecting the immune response. In Holborow, E.J. and Reeves, W.G. (eds.) Immunology in Medicine, p. 1067. (London: Academic Press)

    Google Scholar 

  19. Berenbaum, M.C. (1975). The clinical pharmacology of immunosuppressive agents. In Gell, P.G.H., Coombs, R.R.A. and Lachman, P.J. (eds.) Clinical Aspects of Immunology, p. 689. (Oxford: Blackwell Scientific)

    Google Scholar 

  20. Borel, J.F., Feurer, C, Gubler, H.U. and Stahelin, H. (1976). Biological effects of cyclosporin-A: a new antilymphocytic agent. Agents Actions, 6, 468

    Article  PubMed  CAS  Google Scholar 

  21. Dreyfuss, M., Harri, E., Hofmann, H., Kobel, H., Pache, W. and Tscherter, H. (1976). Cyclosporin-A and C: new metabolites from Trichoderma polysporum. Eur. J. Appl. Microbiol., 3, 125

    Article  CAS  Google Scholar 

  22. White, D.J.G. (ed.) (1982). Cyclosporin-A. (Amsterdam: Elsevier Biomedical)

    Google Scholar 

  23. Morris, P.J. (1981). Cyclosporin-A. Transplantation, 32, 349

    Article  PubMed  CAS  Google Scholar 

  24. Borel, J.F. (1982). Immunological properties of cyclosporin-A. Heart Transplant., 1, 237

    Google Scholar 

  25. Andreone, P.A, Olivari, M.T., Elick, B., Arentzen, C.E, Sibley, R.K., Bolman, R.M., Simmons, R.L. and Ring, W.S. (1986). Reduction of infectious complications following heart transplantation with triple-drug immunotherapy. J. Heart Transplant., 5, 13

    PubMed  CAS  Google Scholar 

  26. Donatsch, P., Abisch, E., Homberger, M., Traber, R., Trapp, M. and Voges, R. (1981). A radioimmunoassay to measure cyclosporin-A in plasma and serum samples. J. Immunoassay, 2, 19

    Article  PubMed  CAS  Google Scholar 

  27. Sgoutas, D.S. and Hammarstrom, M. (1989). Comparison of specific radioimmunoassays for cyclosporine. Transplantation, 47, 668

    Article  PubMed  CAS  Google Scholar 

  28. Schroeder, T.J., Brunson, M.E., Pesce, A.J., Hindenlang, L.L., Mauser, P.A., Ruckrigl, D.I., Weibel, M.L., Wadih, G. and First, M.R. (1989). A comparison of the clinical utility of the radioimmunoassay, high-performance liquid chromatography, and TDx cyclosporine assays in outpatient renal transplant recipients. Transplantation., 47, 262

    Article  PubMed  CAS  Google Scholar 

  29. Gmur, D.J. (1985). Modified column-switching high-performance liquid chromatographic method for measurement of cyclosporin in serum. J. Chromatogr., 344, 422

    Article  PubMed  CAS  Google Scholar 

  30. Speck, R.F., Frey, FJ. and Frey, B.M. (1989). Cyclosporine kinetics in renal transplant patients as assessed by high-performance liquid chromatography and radioimmunoassay using monoclonal and polyclonal antibodies. Transplantation, 47, 802

    Article  PubMed  CAS  Google Scholar 

  31. Lake, K.D. (1988). Cyclosporine drug interactions: a review. Cardiac Surgery: State of the Art Reviews, 2, 617

    Google Scholar 

  32. Calne, R.Y. (1961). Inhibition of the rejection of renal homografts in dogs by purine analogues. Transplant. Bull., 28, 65

    PubMed  CAS  Google Scholar 

  33. Hersh, E.M., Carbone, P.P. and Freireich, E.J. (1966). Recovery of immune responsiveness after drug suppression in man. J. Lab. Clin. Med., 67, 566

    CAS  Google Scholar 

  34. Gleason, R.E. and Murray, J.E. (1967). Report from Kidney Transplant Registry: analysis of variables in the function of human kidney transplants. Transplantation, 5, 360

    Google Scholar 

  35. Kries, H., Lacombe, M., Noel, L.H., Descamps, J.M., Chailley, J. and Crosnier, J. (1978). Kidney graft rejection: has the need for steroids to be re-evaluated? Lancet, 2, 1169

    Article  Google Scholar 

  36. Goodwin, W.E., Kaufman, J.J., Mims, M.M., Turner, R.D., Glassock, R., Goldman, R. and Maxwell, M.M. (1963). Human renal transplantation. I. Clinical experiences with six cases of renal homotransplantation. J. Urol., 89, 13

    PubMed  CAS  Google Scholar 

  37. Salaman, J.R. and Couhig, E. (1980). Timing of anti-rejection therapy. Transplantation, 29, 468

    Article  PubMed  CAS  Google Scholar 

  38. Gilbert, E.M., Renlund, D.G., O’Connell, J.B., Eiswirth, C.C., Rothstein, G., Gay, W.A., Bristow, M.R. and the Utah Cardiac Transplant Program (1987). Immunosuppressive efficacy of vincristine in heart transplantation: a preliminary report. J. Heart Transplant., 6, 369

    PubMed  CAS  Google Scholar 

  39. Woodruff, M.F. and Anderson, N.F. (1963). Effects of lymphocyte depletion by thoracic duct fistula and administration of antilymphocytic serum on the survival of skin homografts in rats. Nature (London), 200, 702

    Article  CAS  Google Scholar 

  40. Touraine, J.L., Malik, M.C. and Traeger, J. (1981). Antilymphocyte globulin and thoracic duct drainage in renal transplantation. In Salaman, J.R. (ed.) Immunosuppressive Therapy, p. 55. (Lancaster: MTP Press)

    Google Scholar 

  41. Nagaya, H. and Sieker, H.O. (1965). Allograft survival: effect of antiserums to thymus glands and lymphocytes. Science, 150, 1181

    Article  PubMed  CAS  Google Scholar 

  42. Davis, R.C., Cooperband, S.R. and Mannick, J.A. (1969). Preparation and in vitro assay of effective and ineffective antilymphocyte sera. Surgery, 66, 58

    PubMed  CAS  Google Scholar 

  43. Levey, R.H. and Medawar, P.B. (1966). Some experiments on the action of antilymphoid antisera. Ann. N.Y. Acad. Sci., 129, 164

    Article  Google Scholar 

  44. Cooley, D.A., Hallman, G.L., Bloodwell, R.D., Nora, J.J. and Leachman, R.D. (1968). Human heart transplantation: experience with 12 cases. Am. J. Cardiol., 22, 804

    Article  PubMed  CAS  Google Scholar 

  45. Baumgartner, W.A., Reitz, B.A., Oyer, P.E., Stinson, E.B. and Shumway, N.E. (1979). Cardiac homotransplantation. Curr. Probl. Surg., 16, 1

    Article  PubMed  CAS  Google Scholar 

  46. Gilbert, E.M., De Witt, C.W., Eiswirth, C.C., Renlund, D.G., Menlove, R.L., Freedman, L.A., Herrick, C.M., Gay, W.A. and Bristow, M.R. (1987). Treatment of refractory cardiac allograft rejection with OKT3 monoclonal antibody. Am. J. Med., 82, 203

    Article  Google Scholar 

  47. Bristow, M.R., Gilbert, E.M., Renlund, D.G., De Witt, C.W., Burton, N.A. and O’Connell, J.B. (1988). Use of OKT3 monoclonal antibody in cardiac transplantation: review of the initial experience. J. Heart Transplant., 7, 1

    Google Scholar 

  48. Bristow, M.R., Gilbert, E.M., O’Connell, J.B, Renlund, D.G, Watson, F.S, Hammond, E, Lee, R.G. and Menlove, R. (1988). OKT3 monoclonal antibody in heart transplantation. Am. J. Kidney Dis., 11, 135

    PubMed  CAS  Google Scholar 

  49. Jaffers, G.J, Fuller, T.C, Cosimi, A.B., Russell, P.S., Winn, H.J. and Colvin, R.B. (1986). Monoclonal antibody therapy: anti-idiotypic and non-anti-idiotypic antibodies to OKT3 arising despite intense immunosuppression. Transplantation, 41, 572

    Article  PubMed  CAS  Google Scholar 

  50. Medleau, L, Dawe, D.L. and Calvert, C.A. (1983). Immunosuppressive effects of cyclophosphamide, vincristine and L-asparaginase in dogs. Am. J. Vet. Res., 44, 176

    PubMed  CAS  Google Scholar 

  51. Sensenbrenner, L.L, Owens, A.H, Zawatzsky, L.S. and Elfenbein, J (1972). The comparative effects of selected cytotoxic agents on transplanted hematopoietic cells. Transplantation, 14, 347

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Kluwer Academic Publishers

About this chapter

Cite this chapter

Cooper, D.K.C. (1990). Immediate Postoperative Care and Maintenance Immunosuppressive Therapy. In: Cooper, D.K.C., Novitzky, D. (eds) The Transplantation and Replacement of Thoracic Organs. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0711-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-0711-9_12

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6805-5

  • Online ISBN: 978-94-009-0711-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics