Case report of heart transplantation for giant cell myocarditis in a patient with common variable immunodeficiency

Abstract Background Solid-organ transplantation in patients with common variable immunodeficiency (CVID) is controversial due to the risk for severe and recurrent infections. Determining transplantation candidacy in CVID patients is further complicated by the presence of CVID-related non-infectious...

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Bibliographic Details
Published in:European heart journal : case reports 2021-12, Vol.5 (12), p.ytab447
Main Authors: Franzon, Thomas A, Kovalszki, Anna, Rabah, Raja, Nicklas, John M
Format: Article
Language:English
Subjects:
Grand Round
Health aspects
Heart
Heart failure
Immunological deficiency syndromes
Infection
Myocarditis
Shock
Transplantation
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Summary:Abstract Background Solid-organ transplantation in patients with common variable immunodeficiency (CVID) is controversial due to the risk for severe and recurrent infections. Determining transplantation candidacy in CVID patients is further complicated by the presence of CVID-related non-infectious complications that can reduce overall survival and also recur in the transplanted organ. Data regarding solid organ transplantation in patients with CVID are limited, particularly in heart transplantation. Case summary A 32-year-old female with CVID presented with new heart failure after 3 months of dyspnoea on exertion. Her echocardiogram showed severe global systolic dysfunction with an ejection fraction of approximately 10%, and her right heart catheterization revealed severe biventricular pressure overload and severely reduced cardiac output. Endomyocardial biopsy revealed giant cells and mononuclear infiltrate consistent with giant cell myocarditis (GCM). Despite medical management, she developed progressive cardiogenic shock and underwent uncomplicated orthotopic heart transplantation on hospital Day 38. After 2 years of follow-up, she has had no major infectious complications and continues to have normal graft function with no recurrence of GCM. Conclusion We report a case of successful heart transplantation for GCM in a patient with CVID, with no major infectious complications after 2 years of follow-up. CVID should not be considered an absolute contraindication for heart transplantation. Graphical Abstract Graphical Abstract
ISSN:2514-2119
2514-2119
DOI:10.1093/ehjcr/ytab447