Info

Fig. 13A.4. "Bicaval" Cardiac Transplantation. In the first panel the recipient cardiectomy has been completed. Note the entire recipient right atrium has been removed. The second panel shows the completed implant. The sequence of anastomoses are: 1) left atrial (LA), 2) Aortic (Ao), 3) inferior vena cava (IVC), 4) pulmonary artery (PA), 5) superior vena cava (SVC).

Fig. 13A.4. "Bicaval" Cardiac Transplantation. In the first panel the recipient cardiectomy has been completed. Note the entire recipient right atrium has been removed. The second panel shows the completed implant. The sequence of anastomoses are: 1) left atrial (LA), 2) Aortic (Ao), 3) inferior vena cava (IVC), 4) pulmonary artery (PA), 5) superior vena cava (SVC).

as an IV drip at 0.05-0.1 mg/kg/hr and continued for 2-3 days until gastrointestinal function is normal. At that time the patient is converted to oral cyclosporine dosing: 5-15 mg/kg/day given by mouth; t.i.d. dosing in newborns, b.i.d. in older children. We have used the enzyme multiplied immunoassay technique (EMIT) for monitoring the level and have kept that level at 250-300 ng/ml for the first 6 months, 200 ng/ml after 6 months, and at 150 ng/ml after 1 year. After a short (3 day) course of IV Solu-Medrol (10 mg/kg/day, day 1; 5 mg/kg/day, day 2; 3 mg/kg/ day, day 3), prednisone is initiated at 1 mg/kg/day p.o. and tapered every two weeks until 0.2 mg/kg is reached by 8 weeks posttransplant. In neonates, prednisone is tapered off 6 months posttransplant. We previously used Azathioprine (1-2 mg/ kg/day) but have converted to the use of Cellcept (mycophenolate mofetil). Cellcept is given at an initial dose of 50 mg/kg/day and titrated to a WBC count of 5,000-10,000. Some centers use OK-T3 (murine monoclonal antibody) for induction therapy. Dose is 2.5 to 10 mg daily IV for 10-14 days. Other centers have reported the use of anti-thymocyte globulin (ATG) and antilymphocyte globulin

0 0

Post a comment