Correspondence

Cardiac Transplantation in an HIV-1–Infected Patient

N Engl J Med 2003; 349:1388-1389October 2, 2003

Article

To the Editor:

Calabrese et al. (June 5 issue)1 describe cardiac transplantation in a patient with a 15-year history of human immunodeficiency virus type 1 (HIV-1) infection and multiple opportunistic infections who had dilated cardiomyopathy due to daunorubicin therapy. Two years ago, we performed a cardiac transplantation in a 42-year-old man with a two-year history of HIV infection, an undetectable viral load, a CD4 cell count of 637 per cubic millimeter, and no history of opportunistic infections; the patient had dilated cardiomyopathy and an ejection fraction of 10 percent. The patient's hospital course was unremarkable, and he was discharged on the ninth day after surgery. No opportunistic infections have developed, and the patient has returned to work. He is receiving maintenance therapy consisting of antiretroviral drugs in addition to low-dose immunosuppressive therapy. Unlike the patient described by Calabrese et al., our patient has not had any clinically significant episodes of rejection.

Improvements in the management of HIV infection have resulted in delayed progression and extended survival, with an increasing number of patients presenting with end-organ dysfunction.2-4 We agree with the authors' supposition that it is important to report individual cases of transplantation into HIV-positive recipients, although longer follow-up is needed in a greater number of patients before definitive statements can be made regarding the outcomes and the allocation of scarce resources.

Jeffrey A. Morgan, M.D.
Gianluigi Bisleri, M.D.
Donna M. Mancini, M.D.
Columbia University, New York, NY 10032
jm2240@columbia.edu

4 References

1. 1

   Calabrese LH, Albrecht M, Young J, et al. Successful cardiac transplantation in an HIV-1-infected patient with advanced disease. N Engl J Med 2003;348:2323-2328
   Full Text | Web of Science | Medline

2. 2

   Roland ME, Havlir DV. Responding to organ failure in HIV-infected patients. N Engl J Med 2003;348:2279-2281
   Full Text | Web of Science | Medline

3. 3

   Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998;338:853-860
   Full Text | Web of Science | Medline

4. 4

   Roland ME, Stock PG. Review of solid-organ transplantation in HIV-infected patients. Transplantation 2003;75:425-429
   CrossRef | Web of Science | Medline

To the Editor:

In their description of cardiac transplantation in a patient with AIDS, Calabrese et al. mention the development of refractory anemia during treatment with erythropoietin. Was the patient tested for antierythropoietin antibodies? Casadevall et al. described 13 patients in whom refractory anemia and pure red-cell aplasia developed during treatment with recombinant erythropoietin.1 Could the red-cell hypoplasia in the patient described by Calabrese et al. be part of the spectrum of refractory anemia caused by antibodies to recombinant erythropoietin?

Another facet of this case merits greater emphasis than the authors and the editorialist afforded it: the patient has a doctoral-level education. Whether these results can be duplicated in other patients with AIDS who require organ transplantation may well hinge on whether these patients have a similar capacity to understand and comply with the complex treatment regimens that are required.

Scott K. Aberegg, M.D., M.P.H.
Johns Hopkins Hospital, Baltimore, MD 21205
scottaberegg@hotmail.com

1 References

1. 1

   Casadevall N, Nataf J, Viron B, et al. Pure red-cell aplasia and antierythropoietin antibodies in patients treated with recombinant erythropoietin. N Engl J Med 2002;346:469-475
   Full Text | Web of Science | Medline

Author/Editor Response

The report by Morgan and colleagues is both interesting and important, and we encourage them to publish it in article form, including their data on any pharmacokinetic interactions among antiretroviral agents and transplantation-related medications. Given the early phase of our experience with transplantation in HIV-positive patients, all such reports are valuable.

Dr. Aberegg raises an interesting and important point. At present, our patient is being tested for antierythropoietin antibodies.

Leonard H. Calabrese, D.O.
Cleveland Clinic Foundation, Cleveland, OH 44195
calabrl@ccf.org

Citing Articles (3)

Citing Articles

1. 1

   James A. DiNardo, Avinash C. Shukla, Francis X. McGowan. 2011. Anesthesia for Congenital Heart Surgery. , 605-673.
   CrossRef

2. 2

   Carlos-Alberto Mestres, José Maria Miró, . (2006) The surgical treatment of infective endocarditis: An overview. Indian Journal of Thoracic and Cardiovascular Surgery 22:1, 28-35
   CrossRef

3. 3

   Kerri M. Robertson, Avinash C. Shukla, Francis X. McGowan, David S. Beebe, Kumar G. Belani, Victor L. Scott. 2006. Anesthesia for Pediatric Organ Transplantation. , 895-974.
   CrossRef