Noninfectious Complications Of Cardiac Transplantation

In addition to common forms of cancer, those malignancies associated with chronic immunosuppression also occur in cardiac transplant recipients. These include posttransplant lymphoproliferative disorders (PTLDs), which are usually B-cell lymphomas and have been related to the Epstein-Barr virus. PTLDs may occur as early as 1 month posttransplantation and may present with a variety of nonspecific symptoms. If diagnosed in their early stages, they may respond to decreased levels of immunosuppression, chemotherapy, and/or radiation therapy, with long-term survival reported.

Aseptic necrosis of the femoral heads and thoracic and lumbar spine compression fractures are not uncommon manifestations of long-term steroid therapy. The development of hip pain referred to the medial thigh or knee is often indicative of early aseptic necrosis. Magnetic resonance imaging (MRI) is the most sensitive means of detection, and patients should be referred for orthopedic evaluation if this diagnosis is suspected.

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