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Ann Thorac Surg 1984;38:169-171
© 1984 The Society of Thoracic Surgeons

Articles

Total Lymphatic Irradiation and Bone Marrow in Human Heart Transplantation

Donald R. Kahn, M.D.*, Richard Hong, M.D., Alvin J. Greenberg, M.D., Enid F. Gilbert, M.D., Guillermo C. Dacumos, M.D., John H. Dufek, P.A.

Baptist Medical Center-Princeton, Birmingham, AL the University of Wisconsin Center for Health Sciences, Madison, WI

Accepted for publication February 10, 1984.

* Address reprint requests to Dr. Kahn, 817 Princeton Ave SW, Suite 300, Birmingham, AL 35211

Six patients, aged 36 to 59 years, had heart transplants for terminal myocardial disease using total lymphatic irradiation (TLI) and donor bone marrow in addition to conventional therapy. All patients were poor candidates for transplantation because of marked pulmonary hypertension, unacceptable tissue matching, or age.

Two patients are living and well more than four years after the transplants. Two patients died of infection at six and seven weeks with normal hearts. One patient, whose preoperative pulmonary hypertension was too great for an orthotopic heart transplant, died at 10 days after such a procedure. The other patient died of chronic rejection seven months postoperatively.

Donor-specific tolerance developed in 2 patients. TLI and donor bone marrow can produce specific tolerance to donor antigens and allow easy control of rejection, but infection is still a major problem. We describe a new technique of administering TLI with early reduction of prednisone that may help this problem.




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