Immune Tolerance After Total Lymphoid Irradiation for Heart Transplantation: Immunosuppressant-free Survival for 8 Years
Received 9 December 2008; received in revised form 16 March 2009; accepted 7 April 2009. published online 15 May 2009.
A 51-year-old African American man underwent orthotopic heart transplantation in 1995 for post-viral cardiomyopathy. Refractory rejection occurred, and he subsequently required total lymphoid irradiation to prevent further rejection. Disseminated Mycobacterium avium complex developed in 2000, and the patient decided to discontinue all drugs after the antibiotics caused intolerable medication side effects. The patient did not subsequently die of rejection, and he was discovered to have profound suppression of several lymphocytes subsets, presumably from the previous total lymphoid irradiation. This induced immunotolerance appears to have enabled his prolonged immunosuppressant-free survival.
aDepartment of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
bDepartment of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
Reprint requests: George D. Comerci, Jr, MD, University of New Mexico, Department of Internal Medicine, 5 ACC, 211 Lomas Blvd., Albuquerque, NM 87106. Telephone: 505-272-6476
ABSTRACT