PLASMAPHERESIS IN THE TREATMENT OF POSTTRANSPLANT CARDIOMYOPATHY

After heart transplantation a number of factors such as pre-and postop erative hypoxia of the myocardium, myocardial failure of the early pos toperative period, acute rejection episodes, cytomegalovirus infection , and finally the progressive atherosclerosis of the coronary arteries lead to the development of transplanted heart failure. Severe alterat ions of the myocardial function at this end stage of the process corre spond to incurable cardiomyopathy. The target of plasmapheresis in thi s case is to decrease the extent of the disturbances in the lipoprotei n contents and blood rheology for the improvement of the coronary perf usion of the transplanted heart. Nine patients with 3-7 year survival periods after heart transplantations underwent plasmapheresis twice a year using the Haemonetics PCS-plus machine. 2,100-2,700 ml of plasma was removed. Biochemical data, rheology and coagulation, and the conce ntration of Sandimmune (Sandoz Pharma Ltd., Basel, Switzerland) were c ontrolled, and radionuclide scintigraphy of the myocardium, coronarogr aphia, and transesophageal ultrasound investigations were completed fo r these patients. The result was the significant improvement of the co ronary perfusion of the myocardium. The level of immunosuppression aft er the plasmapheresis procedures did not change and therefore did not demand any correction. Thus, we think that plasmapheresis can be an ef fective method of treatment of posttransplantation cardiomyopathy; the improvement of coronary perfusion decreases the extent of chronic isc hemia. Further studies are necessary to answer the question as to whet her it is possible to prolong the time before retransplantation with t he help of plasmapheresis.