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Open Access Case report

Profound hyperacute cardiac allograft rejection rescue with biventricular mechanical circulatory support and plasmapheresis, intravenous immunoglobulin, and rituximab therapy

David J Kaczorowski1, Jashodeep Datta2, Malek Kamoun3, Daniel L Dries4 and Y Joseph Woo1*

Author Affiliations

1 Division of Cardiovascular Surgery, University of Pennsylvania, 3400 Spruce Street, 6 Silverstein Pavilion, Philadelphia, PA, 19104, USA

2 Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

3 Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA

4 Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA

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Journal of Cardiothoracic Surgery 2013, 8:48  doi:10.1186/1749-8090-8-48

Published: 16 March 2013

Abstract

Hyperacute rejection is a rare but potentially catastrophic complication after cardiac transplantation. We describe an unusual case of hyperacute rejection due to preformed anti-donor antibodies despite a negative preoperative panel-reactive antibody (PRA) screen. An excellent outcome was achieved in this case and our strategy involving the use of CentriMag ventricular assist devices (VADs) for biventricular support during treatment with rituximab, intravenous immunoglobulin (IVIG), and plasmapheresis is illustrated.

Keywords:
Heart failure; Heart failure operations; Heart transplant; Circulatory assist devices; Circulatory assistance (temporary)