Death on the waiting list for cardiac surgery in The Netherlands in 1994 and 1995.

Objective: To describe the causes and circumstances of death regarding patients who died in 1994 and 1995 while on a waiting list for cardiac surgery in the Netherlands.

Design: Retrospective multicentre case study.

Setting: 11 Dutch cardiac surgery centres.

Endomyocardial biopsies after heart transplantation. The presence of markers indicative of activation.

A series of 104 endomyocardial biopsies (EMB) from patients after heart transplantation was evaluated for the presence of immunological markers on graft component and infiltrating cells. This included markers for cells expressing alpha beta-T-cell receptors and gamma delta-T-cell receptors, and cytotoxic T cells with granules bearing the serine esterase Granzyme B; the presence of activation markers identified by CD25 (interleukin 2 receptor), CD30, CD69 (activation inducer molecule), CDw70; macrophages using antibody CD14 (WT14), and cells with Fc gamma-receptors type III (CD16). Almost all cells in T-cell infiltrates expressed the alpha beta-T cell receptor.

Early detection of primary cytomegalovirus infection after heart and kidney transplantation and the influence of hyperimmune globulin prophylaxis.

A randomized study of prophylaxis with hyperimmune globulin (HIg) was performed in 28 cytomegalovirus (CMV)-seronegative heart and kidney recipients with CMV-seropositive donors who were extensively monitored for active CMV infection and CMV disease. Detection of CMV antigen in peripheral blood granulocytes (antigenemia) was the first sign of primary CMV infection, generally occurring several weeks before IgM or IgG anti-CMV antibodies were detected and before positive cultures appeared. A correlation was found between rejection treatment with OKT3 or ATG, severity of CMV disease, and graft loss.

Ventricular fibrillation during acute rejection after heart transplantation.

The case of a 46-year-old patient who underwent orthotopic heart transplantation for treatment of end-stage heart failure as a result of ischemic heart disease is reported. Four months after transplantation a grade II rejection episode was complicated by ventricular fibrillation. Lidocaine and procainamide intravenously did not effectively prevent recurrence.