[Complications in heart transplantation: diagnosis and treatment].

ACUTE REJECTION: Endomyocardial biopsy is the most reliable method to detect acute rejection but is an invasive procedure. Other non-invasive methods have been proposed including tissular Doppler ultrasonography with analysis of the posterior wall velocity and teletransmitted study of the intramyocardial amplitude of the QRS complex. Adding plasmapheresis to the conventional treatment is helpful in improving survival and reducing the incidence of late coronary disease after severe acute reflection. Plasmapheresis also has a preventive effect as do certain inductors such as anti-thrombocyte globulin (ATG).

INFECTION: Opportunistic infections are the leading cause of mortality in the year following heart transplantation, generally related to the hypogammaglobulinemia. Intravenous immunoglobulins have helped reduce the frequency of infections.

CANCER: More than 1/3 of donor cancers diagnosed after transplantation will be transmitted to the cardiothoracic organ recipient. Melanoma, choriocarcinoma and renal carcinoma with vascular effraction are the most transferable tumors.

DIABETES: Survival at 5 years is lower in heart transplant recipients but at 10 years the incidence of coronary artery disease and infection are the same. However at 10 years, creatininemia is higher as is the frequency of lower limb arteropathies. RHABDOMYOLYSIS: The incidence of rhabdomyolysis after heart transplantation in patients treated with statin is much higher than in the general population, but complementary studies are needed to compare the muscular effects of the different statins in transplant recipients.

CORONARY ARTERY DISEASE: Coronary artery disease of the graft is the leading cause of late mortality. The known risk factors can be limited by normalizing blood pressure and lipidemia and using ATG to prevent rejection. GROWTH OF THE GRAFT IN CHILDREN: Growth of the graft has been demonstrated in 17 recipients aged less than 13 years at the time of transplantation. Growth was linear and followed the child's weight and height curves. Ultrasound measures normalized 6 months after transplantation. PREGNANCY: The graft continues to function normally in female heart transplant recipients during pregnancy and post-portum. Complementary studies are needed to determine the long-term effect.