Should patients with systemic lupus erythematosus (SLE) RECEIVE a heart transplant?
Medicine and Health Sciences
This was a case study on a patient with SLE who received a heart transplant. Patients with SLE are generally not considered to be ideal candidates for transplantation due to auto-immunity involving many organ systems. Historically, patients with SLE requiring kidney transplantation have had good prognosis, but there is a weaker consensus sur-rounding heart transplantation in patients with SLE-related cardiomyopathy and heart failure. A 24-year-old female patient presented in 2016 with cardiogenic shock with a history of non-ischemic dilated cardiomyopathy with an ejection fraction of 5-10% and SLE com-plicated by nephritis. She required 2-3 hospital visits per year due to heart failure and SLE complications. A chest X-ray revealed cardiomegaly with hypo-inflated lungs. She was placed on inotropic support and followed up with a heart transplant in 2017. During transplantation, her heart was found to have dense adhesions resulting from SLE. In 2018, the patient returned with acute kidney injury and chronic kidney disease (CKD) Stage 3 with metabolic acidosis and a diastolic dysfunction. Her chest X-ray presented with mild cardiomegaly and a kidney ultrasound was negative for hydronephrosis. She was diagnosed with NYHA class III heart failure and was prescribed torsemide and a therapeutic plan to begin her on allopurinol due to her reduced GFR. After immunosup-pressive therapy, her Stage IV lupus nephritis was not active at the time of her dis-charge. Conclusion: This case demonstrates the ongoing challenges that physicians encoun-ter when managing patients with SLE-related cardiac involvement. The literature cites no clear consensus regarding management of patients with cardiac involvement of SLE, especially considering the large range of cardiac involvement. This case supports the growing need for understanding and managing cardiac involvement in patients with SLE.
Copyright 2019 all authors
Zafar,, Nayab BSc, OMS-2; Sehgal, Neha MS, OMS-2; and Kelly, K. J. MD, MSc, "Should patients with systemic lupus erythematosus (SLE) RECEIVE a heart transplant?" (2019). MU-COM Research Day. 130.