利妥昔单抗在肾移植后抗体介导排斥反应中的作用

背景:国外研究表明,利妥昔单抗在肾移植后抗体介导的排斥反应中具有良好的安全性及有效性,但中国尚缺乏此类研究及报道.目的:探讨利妥昔单抗在肾移植后抗体介导的排斥反应中的安全性和有效性.方法:将肾移植后病理诊断为抗体介导的排斥反应的患者18例分为2组,均进行免疫抑制治疗,药物组8例采用单剂利妥昔单抗治疗;对照组10例不使用利妥昔单抗治疗.结果与结论:用药后6,12个月,药物组肌酐水平均低于同期对照组(P<0.05).用药后随访6-12个月,药物组1例患者出现巨细胞病毒血症,1例患者出现泌尿系感染,随访期间无威胁生命的感染发生,人/肾存活率为100%.结果证实,利妥昔单抗在治疗肾移植移植后抗体介导的排斥反应中安全有效.     

HLA配型和PRA对移植肾功能的影响研究

目的 研究肾移植患者人白细胞抗原(HLA)配型和群体反应性抗体(PRA)与移植后肾功能的关系.方法 根据肾移植术前HLA配型结果,观察HLA配型和PRA对肾移植受者术后急性排斥反应发生率和移植肾功能的影响.结果 121例尸体肾移植受者肾移植术后发生急性排斥反应的有15例,占12.40%;6例PRA阳性,占4.96%;2...     

活体肾移植急性排斥反应的临床特点及转归

背景:临床实践中发现活体肾移植急件排斥反应并不少见,耐激素导致的排斥反应屡有发生,且临床表现不典型,易漏诊、误诊,严重者导致移植失败,影响人/肾长期存活率.目的:探讨活体肾移植急性排斥反应临床特点及转归.方法:通过回顾性分析比较2005-02/2008-09活体肾移植192例和尸体肾移植168例急性排斥反应的临床表现、并发症及治疗转归,对活体肾移植急性排斥反应特点进行分析.结果与结论:活体肾移植和尸体肾移植急性排斥反应及耐激素排斥反应发生率分别为9.8%,46_2%和22.8%,57.8%,差异有显著性意义(P<0.05).活体肾移植急性排斥反应时发热,移植肾区疼痛、血尿、尿少等症状及感染、肾周血肿等并发症少于尸体肾移植.活体肾移植19例急性排斥反应经强化治疗全部逆转,而尸体肾移植38例急性排斥反应,35例逆转,2例破裂切除,1例肾静脉血栓形成.临床分析提示,活体肾移植较尸体肾移植急性排斥反应发生率低,耐激素急性排斥反应少,临床表现轻,易逆转,预后好,同时活体肾移植急性排斥反应临床表现不典型,耐激素排斥率较高,因此在临床工作中应密切观察肾功能变化,及时发现,及时处理.     

利妥昔单抗在肾移植后抗体介导排斥反应中的作用

背景：国外研究表明,利妥昔单抗在肾移植后抗体介导的排斥反应中具有良好的安全性及有效性,但中国尚缺乏此类研究及报道。目的：探讨利妥昔单抗在肾移植后抗体介导的排斥反应中的安全性和有效性。方法：将肾移植后病理诊断为抗体介导的排斥反应的患者18例分为2组,均进行免疫抑制治疗,药物组8例采用单剂利妥昔单抗治疗;对照组10例不使用利妥昔单抗治疗。结果与结论：用药后6,12个月,药物组肌酐水平均低于同期对照组（P〈0.05）。用药后随访6-12个月,药物组1例患者出现巨细胞病毒血症,1例患者出现泌尿系感染,随访期间无威胁生命的感染发生,人/肾存活率为100%。结果证实,利妥昔单抗在治疗肾移植移植后抗体介导的排斥反应中安全有效。     

单剂量巴利昔单抗对肾移植受者外周血Foxp3mRNA、CD4+CD25+调节性T细胞、白细胞介素2及其受体的影响

目的观察单剂量巴利昔单抗对肾移植受者外周血Foxp3mRNA、CD4+CD25+调节性T细胞、白细胞介素2及可溶性白细胞介素2受体的影响,分析其预防移植肾急性排斥反应的作用途径.方法选择2005-10,2006-12在上海解放军第四五五医院行同种异体肾移植的患者66例,移植前均行维持性血液透析治疗.按随机数字表法分为2组,常规组接受常规免疫抑制剂治疗,巴利昔单抗组在常规免疫抑制剂治疗的基础上加用巴利昔单抗(商品名舒莱,诺华制药公司,批号S20040059,20 mg/瓶),每组33例.另外选择年龄性别相配的健康体检者30例作为对照组.以上所有观察对象均知情同意,且得到医院伦理道德委员会批准.两组肾移植患者分别于移植前(手术当天)和移植后1,2,4,8周清晨采静脉血肝素抗凝,以流式细胞仪检测外周血中CD4+CD25+调节性T细胞含量,应用荧光定量PCR检测Foxp3mRNA的表达,应用双抗体夹心酶联免疫吸附法检测血浆中自细胞介素2及其受体,采用生化仪检测血肌酐及尿素氮水平,必要时行移植肾多普勒超声检查和病理活检,观察其急性排斥反应发生情况.结果66患者全部进入结果分析,无脱落.①常规组患者急性排斥反应的发生率21.12%(7/33)显著高于巴利昔单抗组6.1%(2/33)(p＜0.05).②移植后第1,2,4和8周巴利昔单抗组Foxp3、CD4+CD25+调节性T细胞和白细胞介素2水平均高于常规组(P＜0.05～0.01),可溶性白细胞介素2受体水平均低于常规组[(306.31±98.43,327.60±109.74,316.71±104.54,388.33±13242;410.14+112.04,442.82±118.94,450.80±123.63,445.61±115.24)U/mL(p＜0.05～0.01)].③两组肾移植患者无论移植前还是移植后,其血浆CD4+CD25+调节性T细胞百分率与Foxp3mRNA表达水平均呈明显正相关(r=0.892～0.932,P＜0.01).结论单剂量巴利昔单抗可以有效地减少移植肾急性排斥反应的发生率,作用途径可能与其增加外周血中Foxp3mRNA、CD4+CD25+调节性T细胞和白细胞介素2表达,减少血浆可溶性白细胞介素2受体水平有关.     

供者特异性活化T细胞频度预测肾移植急性排斥反应

背景：提高移植后排斥反应风险预报的准确性,可为移植后个体化使用免疫抑制剂提供参考。目的：寻找一种能定量分析供受者间免疫反应强度的方法来预测急性排斥反应。方法：对同种异体尸肾移植的患者115例采用前瞻性分析,用ELISPOT法检测移植前分泌γ-干扰素的供者特异性活化T细胞的频度,观察随访期内有无急性排斥及肺部感染,并观察HLA错配与急性排斥的关系。结果与结论：115例群体反应性抗体阴性肾移植受者中有25例发生急性排斥反应,发生急性排斥反应患者的供者特异性活化T细胞频度高于未发生急性排斥反应者（P〈0.01）,而HLA-I、II及总的错配数比较,差异均无显著性意义（P〉0.05）。提示,通过移植前对产生γ-干扰素的供者特异性活化T细胞频度的检测,可预测急性排斥反应,对潜在供者进行选择。     

供者特异性活化T细胞频度预测肾移植急性排斥反应

背景:提高移植后排斥反应风险预报的准确性,可为移植后个体化使用免疫抑制剂提供参考。目的:寻找一种能定量分析供受者间免疫反应强度的方法来预测急性排斥反应。方法:对同种异体尸肾移植的患者115例采用前瞻性分析,用ELISPOT法检测移植前分泌γ-干扰素的供者特异性活化T细胞的频度,观察随访期内有无急性排斥及肺部感染,并观察HLA错配与急性排斥的关系。结果与结论:115例群体反应性抗体阴性肾移植受者中有25例发生急性排斥反应,发生急性排斥反应患者的供者特异性活化T细胞频度高于未发生急性排斥反应者(P<0.01),而HLA-I、II及总的错配数比较,差异均无显著性意义(P>0.05)。提示,通过移植前对产生γ-干扰素的供者特异性活化T细胞频度的检测,可预测急性排斥反应,对潜在供者进行选择。     

人脐带间充质干细胞体外向胰岛样细胞诱导分化及其治疗糖尿病效果

背景:相对于其他来源的干细胞而言,脐带间充质干细胞免疫排斥反应和免疫原性较小,但并不等同于无任何免疫排斥反应.目的:观察人脐带间充质干细胞体外向胰岛样细胞的诱导分化,及其移植后对槠尿病大鼠的治疗效果.设计、时间及地点:细胞学体内对照观察,于2008-11在辽宁医学院解剖学教研室实验窀完成.材料:清洁级雄性SD大鼠36只,随机分为4组:胰岛样细胞组12只、间充质干细胞组12只、模型对照组6只、正常对照组6只.人脐带间充质干细胞由天津国家干细胞中心提供.方法:取传至第3代的人脐带间充质干细胞,待细胞融合至70%～80%后,换用含碱性成纤维细胞生长因子、尼克酰胺的DMEM高糖培养基,向胰岛样细胞诱导分化.除正常对照组外,其余3组大鼠均腹腔注射链脲佐菌素建屯糖尿病模型.造模后,胰岛样细胞组于肾被膜下植入胰岛样细胞2× 106个,间充质干细胞组同法植入等量未诱导的脐带间充质干细胞,模型对照组植入不含任何细胞的培养液1 mL.主要观察指标:诱导后胰岛样细胞的鉴定,胰岛样细胞的移植效果.结果:诱导前脐带间充质干细胞呈长梭形贴壁生长;诱导4 d后细胞向中央聚集,出现胰岛样细胞团,此后胰岛样细胞团逐渐增大且数量增多;诱导7d双硫腙染色呈阳性表达.移植后2周,胰岛样细胞组血糖浓度明显降低,一直维持至第6周;间充质干细胞组血糖浓度在移植后很快下降,但4周后皿糖浓度上升;模型对照组血糖浓度一直处于糖尿病血糖浓度范围内.免疫组化染色结果显示,移植后4周胰岛样细胞组胰腺管腔内可见大量胰岛素表达,间充质干细胞组仪有表达少量胰岛素,正常对照组胰岛素表达无明显变化.结论:人脐带间充质干细胞体外可诱导分化为胰岛样细胞.与脐带间充质干细胞相比,胰岛样细胞能够较长时间维持大鼠血糖浓度在正常水平,且植入后可迅速发挥降糖作用.     

亲属活体肾移植过程中非清髓同源造血干细胞序列移植术的护理技术:1例报告

解放军第一五三中心医院于2000-04对1例慢性肾功能衰竭患者实施了序列式亲属活体肾移植/非清髓同源造血干细胞移植,患者为男性,23岁,供体为其母亲.肾移植术后在非清髓治疗前提下一次性输注同源造血干细胞,检测受体内微嵌合体,观察排斥反应、感染、移植物抗宿主反应的发生情况,统计免疫抑制剂的使用量并与未进行造血干细胞移植者对比;在不同的治疗过程中制定不同的护理计划并实施.受者于术后3个月内可查到与供者相同的新增HLA-DR位点,术后3年持续存在,免疫抑制剂使用量仅为未进行造血干细胞移植者的一半,术后随访7年,无排斥反应发生.活体肾移植术后延迟性非清髓造血干细胞移植可使受者产生微嵌合体,有可能产生免疫耐受.     

肾移植前透析时间对移植后眼部并发症的影响

背景:肾移植后眼部并发症主要与年龄、引起肾功能衰竭的原发病、体内毒性物质的长期累积及激素和免疫抑制剂的长期应用有关.肾移植前透析时间对移植后某些眼部并发症是否有影响有待验证.目的:探讨肾移植前透析时间对移植后眼部并发症的影响.方法:选择159例肾移植后门诊随访患者,男108例,女51例,年龄(40.3±8.7)岁;肾移植时间为(3,8±2.1)年,肾移植前透析时间为(2.7±1.9)年;尸体肾移植81例,亲属肾移植78例.调查108例眼部并发症情况,对肾移植前不同透析时间移植后眼部并发症的发生率进行卡方检验及卡方线性趋势检验.结果与结论:159例肾移植患者中,83例(52.2%)患者至少存在一处眼部并发症,余下的76 例(47.8%)患者眼部检查未发现明显异常,最常见的眼部并发症为睑裂斑/结膜变性,构成比为33.3%;其次为白内障,构成比为26.3%,主要表现为晶状体后极部后囊下出现灰白色颗粒状、斑块状混浊,可见空泡和水隙.4例(3.5%)青光眼患者经房角镜检查前房角均为开角,视野检查发现旁中心暗点1例,弓形暗点2例,鼻侧阶梯1例.结果显示肾移植前透析时间与移植后青光眼的发生有关,透析时间越久青光眼的发生率越高.     

肾移植后急性排异反应12例

背景：同种异体肾移植后发生的急性排斥反应是移植肾功能减退和最终移植肾丧失的最主要原因之一。有效预防和早期发现与治疗急性排异反应是关系到肾脏移植患者能否长期存活的重要问题。目的：总结肾移植后1个月内急性排异反应患者治疗过程中免疫抑制剂的应用体会。方法：选择首次肾移植患者12例,移植后采用霉酚酸酯＋环孢素A＋甲泼尼龙三联预防排异反应。当肾移植后3～30d内出现尿量减少、移植肾区胀痛不适、血肌酐升高、尿蛋白增加等不同临床表现,确诊为肾移植后急性排斥反应时,先选用甲强龙500mg/d静脉滴注,连续3d。然后改甲泼尼龙24mg口服1次/d,每5～7d递减4mg,至8mg/d维持。结果与结论：12例患者成功逆转,其中6例甲强龙冲击疗法成功;不能逆转者选用抗胸腺细胞球蛋白或CD3治疗。4例经抗胸腺细胞球蛋白治疗患者中1例8h内尿量迅速增加,2例24h内尿量迅速增加,1例72h后尿量迅速增加;1例选用CD3治疗48h内尿量迅速增加;1例将环孢素转换为他克莫司治疗,同时服用霉酚酸酯胶囊和甲泼尼龙片。经以上治疗12例患者肾功能逐渐恢复。提示肾移植后早期发现、早期诊断、及时治疗是急性排异反应成功逆转的关键。     

Factors influencing Islet of Langerhans graft function and monitoring

Transplantation of islet of Langerhans represents a viable therapeutic option for insulin-dependent diabetes mellitus. Dramatic progress has been recently reported with the introduction of a glucocorticoid-free immunosuppressive regimen that improved success rate, namely, insulin independence for 1 year or more, from 8% to 100%. The fate of islet grafts is determined by many concurrent phenomena, some of which are common to organ grafts (i.e. rejection), while others are unique to nonvascularized cell transplants, including transplant cell mass and viability, as well as nonspecific inflammation at the site of implant. Moreover, islet grafts lack clinical markers of early rejection, making it difficult to recognize imminent rejection and to implement intervention with graft-saving immunosuppressive regimens. In the present review, we will address the problems influencing islet graft success and the monitoring of islet cell graft function.     

Islet transplantation is associated with an improvement of cardiovascular function in type 1 diabetic kidney transplant patients

OBJECTIVE: Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients. RESEARCH DESIGN AND METHODS: We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twenty-five patients did not receive a functioning islet transplant (kidney-only group). RESULTS: GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 +/- 3.5% at baseline to 74.9 +/- 2.1% at 3 years posttransplantation, P < 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 +/- 0.25 to 4.20 +/- 0.37 EDV/s, P < 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P < 0.05). The kidney-islet group also showed a reduction of both QT dispersion (53.5 +/- 4.9 to 44.6 +/- 2.9 ms, P < 0.05) and corrected QT (QTc) dispersion (67.3 +/- 8.3 to 57.2 +/- 4.6 ms, P < 0.05) with higher erythrocytes Na(+)-K(+)-ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness. CONCLUSIONS: Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft.     

Clinical outcome of living donor kidney transplantation across simultaneous ABO and HLA incompatibility: Single center experience of first ten cases

Background and aimsPreconditioning using different protocols has been tested to prevent antibody mediated rejection (ABMR) individually for ABO and HLA incompatibility. However, simultaneous presence of both barriers is still less explored. The aim of this study was to report outcomes of institutional desensitization protocol in renal transplant recipients with simultaneous ABO and HLA incompatibility.Materials and methodsThis was a retrospective study conducted from October 2015 to December 2018. All patients with a clinical diagnosis of dialysis dependent chronic kidney disease (CKD), who were prospective coexistent HLA and ABO incompatible renal transplant recipients were included in the study. Patients were followed up and graft function and patient survival was assessed at 1 y from the date of transplant.ResultsMedian and mode baseline anti-A titers were 64, while median and mode baseline anti-B titers were 256. All recipients were discharged by tenth postoperative day. None of the patients had any bleeding complications. Post transplant infection rate was found to be 20 %. A total of 54 therapeutic plasma exchange (TPE) procedures were performed before transplant and 8 were performed after transplant. Graft survival and patient survival was 100 % at 3, 6, 9, and 12 months. Range and mean follow-up period was 15–42 months and 23 months respectively. Mean glomerular filtration rate (GFR) at 1 y using the CKD-EPI equation was 85.25 ± 13.76 mL/min. Biopsy proven ABMR was observed in one case only which was managed with TPE and immunosuppression.ConclusionSimultaneous ABO and HLA incompatibility in renal transplant recipients can be managed successfully with adequate preconditioning and careful monitoring.     

46例移植肾切除回顾性分析

目的:探讨移植肾切除的原因和手术安全性。方法:回顾分析复旦大学附属中山医院25年来626例肾移植患者中46例移植肾切除的原因和并发症。结果:切除的46例移植肾中急性排斥反应20例(45.20%),慢性排斥反应16例(34.78%),加速排异2例,动脉栓塞1例,感染4例,肾破裂2例和肾动脉破裂1例。感染和出血为术后最多见的并发症,共9例(19.56%),死亡2例(4.34%)。环孢素A(CsA)使用后移植肾切除率7.72%,与CsA使用前的27.78%相比移植肾切除率明显减少(P<0.01)。结论:移植肾切除的主要原因是急慢、性排斥反应。CsA的使用是移植肾切除减少的原因之一。移植肾切除手术风险大,并发症多,手术前后合理的处理可增加手术安全性。     

Changes of plasma fibronectin in patients treated with cryofiltration for an extended period.

The purpose of this study was to evaluate correlations between extra domain A fibronectin (EDA[+]FN) in plasma and the clinical course in cryofiltration for an extended period. Two patients with systemic lupus erythematosus (SLE), 1 with aortitis syndrome, 1 with ankylosis spondylitis, 1 with polymyositis, 1 with rheumatoid arthritis, and 1 with chronic rejection of a kidney graft, were regularly treated with cryofiltration for more than 3 years. The average level of EDA(+)FN in each year did not show significant change in clinically stable patients with aortitis syndrome, polymyositis, and SLE. In the patient with ankylosis spondylitis, the average level of EDA(+)FN in each year elevated, so cryofiltration was performed frequently. On the other hand, cryofiltration could not attenuate the progression in the juvenile rheumatoid arthritis patient. In the patient with chronic rejection of a kidney graft, kidney function without hemodialysis could be prolonged for 33 months by cryofiltration. The average level of EDA(+)FN elevated as the graft function got worse. Changes of average level of EDA(+)FN in plasma corresponded with changes in the clinical courses of patients with autoimmune disease and chronic rejection of a kidney graft. The EDA(+)FN level might give prognostic information and determine the interval of cryofiltration.     

A randomized study comparing leukocyte-depleted versus packed red cell transfusions in prospective cadaver renal allograft recipients

A prospective randomized study at a single renal transplant center between 1980 and 1982 compared the influence of leukocyte-depleted versus packed red cell pretransplantation blood transfusions on patient sensitization to leukocyte (HLA) antigens, likelihood of receiving a graft, and eventual transplantation results. All consenting potential cadaver renal transplant recipients (n = 107) were randomly assigned to receive transfusions at 6-week intervals with either packed red cells (Group 1) or leukocyte-poor red cells (Group 2) until they were transplanted. Actuarial graft and patient survival were identical for graft recipients in both groups. Although the likelihood of receiving a graft was associated with the level of pretransplant sensitization to leukocyte (HLA) antigens (p less than 0.02) as measured by the percent of panel reactive antibody (PRA), it was not associated with the type of blood used. The highest mean peak reactive PRA level for all patients showed a low but significant increase (29 +/- 4 versus 43 +/- 5%; p less than 0.0005) following entry into the transfusion protocol, but the rate of increase was the same for patients in both treatment groups. The likelihood of receiving a transplant was primarily associated with a history of prior graft rejection (p less than 0.05), and patients with prior graft loss had the greatest increase in sensitization following entry into the transfusion protocol. These findings indicate that using leukocyte-poor red cells for pretransplant transfusions provided no added benefit when compared with packed red cells in terms of patient sensitization, the likelihood of receiving a transplant, or eventual graft survival.     

Initial clinical experiences with allotransplantation of the pancreas

Since 1979 7 pancreas transplantations have been performed in 8 type I diabetics. 5 of these 7 recipients had already been dialysed; 2 were awaiting their first dialysis. Furthermore, diabetes had caused severe retinopathy in 5 patients. The pancreas was transplanted simultaneously with a kidney from the same donor in 5 recipients; in 3 cases the pancreas was grafted 16 to 230 days after successful renal transplantation. 1 pancreas graft was removed immediately after revascularisation because of ischaemic damage. While the pancreatic duct was occluded in the first 4 patients, enteric diversion of the pancreatic juice was applied in the next 3 recipients. The first two patients were treated with conventional immunosuppression, whilst all the others received cyclosporin A and low-dose steroids. Small amounts of insulin had to be given initially for a few days in 2 cases, only. 2 grafts were lost due to surgical complications and 3 for immunological reasons. 1 functioning graft had to be removed because the patient was not willing to continue immunosuppression after irreversible rejection of her renal transplant. There was no perioperative death. 2 pancreatic and 5 renal grafts are functioning well at the present time. Technical aspects and problems in the diagnosis of rejection are discussed.     

RANTES and MCP-1 chemokine plasma levels in chronic renal transplant dysfunction and chronic renal failure

OBJECTIVES: Procedures to diagnose renal allograft rejection depend on detection of graft dysfunction due to the presence of mononuclear leukocytic infiltrates. DESIGN AND METHODS: In our study, we pursued an immunodiagnostic approach utilizing an ELISA method on plasma samples to monitor patients waiting to undergo transplantation in order to evidence prognostic developments in renal transplantation and, at least, to diagnose renal chronic transplant dysfunction. We analyzed blood levels of two chemokines, RANTES and MCP-1, which are normally overexpressed locally in renal chronic rejection. RESULTS: Our results showed that patients affected by chronic renal failure (and waiting for kidney transplant), as well as kidney-grafted patients affected by chronic transplant dysfunction, had plasma levels of RANTES significantly higher than those of controls (patients without acute or chronic pathologies). CONCLUSIONS: Our data suggest a simple method to evaluate the plasmatic presence of RANTES, which could be involved in longterm kidney graft failure.     

Cardiac and Multiorgan Transplantation for End-Stage Congenital Heart Disease

ObjectiveTo report our single-center experience with patients who had cardiac and multiorgan transplantation for end-stage congenital heart disease (CHD).Patients and MethodsWe reviewed records for all patients with CHD who had undergone heart transplantation at Mayo Clinic, Rochester, Minnesota, from November 1, 1990, through June 30, 2012. Patients with cardiomyopathy were excluded, unless CHD was present.ResultsOverall, 45 patients had cardiac transplantation for end-stage CHD (mean age, 26.1±18.4 years; range, 1 month to 65 years). Two patients (4%) had combined heart/liver transplantation; 1 (2%) had heart/kidney transplantation. Six patients (13%) had no previous cardiac operation; the remaining 39 patients had a mean of 3 (range, 1-8) previous cardiac operations. Patient survival (95% CI) at 1, 5, and 10 years was 89% (80%-98%), 89% (80%-98%), and 72% (56%-87%), respectively, while graft survival at 1, 5, and 10 years was 89% (80%-98%), 89% (80%-98%), and 61% (44%-78%), respectively. During the same era, the International Society for Heart & Lung Transplantation reported that survival in patients undergoing transplant for non-congenital diagnoses was 85%, 72%, and 56%, respectively. Over a mean follow-up of 8.7±6.2 years, rejection requiring treatment was documented in 35 patients (78%). Eleven patients (24%) have been diagnosed with neoplasia (8 skin, 1 blood, 1 lymph, and 1 other), and 3 patients (7%) have required retransplantation. Four patients (9%) have developed significant coronary vasculopathy; 1 successfully underwent retransplantation, and 3 died 6, 8, and 14 years after transplantation.ConclusionWith appropriate patient selection and posttransplant monitoring, survival has improved for patients with complex end-stage CHD. Multiorgan transplantation is an option for selected patients with CHD.