Cardiology, Heart Transplant, Transplantation
Ref. # 13648
A 47 year old Michigan woman with idiopathic dilated cardiomyopathy received a heart transplant. One year later endomyocardial biopsies showed mild chronic rejection. Three months later, biopsies showed moderate chronic rejection. The institution's transplant program was terminated shortly thereafter. The patient was admitted to its ER with chest pain, sweating, right upper quadrant pain, shortness of breath, nausea and vomiting. The patient reported she had stopped taking anti-rejection medication. Twelve weeks after the transplant program's termination, she was diagnosed with hepatitis vs. cholecystitis and transferred three days later to another hospital with a transplant program, where she died several hours after admittance. A medQuest cardiologist, specializing in congestive heart failure, reported that the treating physicians continuously focused on the patient's GI complaints and deviated from the standard of care by ignoring the transplant rejection as revealed early on by the biopsies. More intensive evaluations, including additional heart biopsies, were required. With appropriate treatment, the patient would have survived.