Heart transplant in India: Gleneagles global experience

Abstract

Introduction: Heart transplant in India was started in 1994. The Indian transplant program differs from the West. In this study, we report the heart transplant experience from Gleneagles Global, Chennai. Materials and Methods: There were 55 patients who underwent a heart transplant during this period. Patients were induced with basiliximab, and the maintenance therapy was with tacrolimus, mycophenolate, and steroids. Results: Fifty patients underwent a heart transplant between 2017 and 2018. The age ranged from 21 to 66 years, and there were 45 males and 10 females. All patients were Class III and IV. Induction for transplant was with basiliximab 10 mg–20 mg. In 54 patients, tacrolimus was used, and low-dose tacrolimus plus everolimus 0.25 mg twice a day was given in five patients. Mycophenolate mofetil was given to all patients. Steroids were given to all patients. In 38 patients, renal function normalized by day 5, and in 12 patients, the renal recovery was delayed to day 10. Two patients needed postoperative dialysis. Three patients died of severe renal failure and sepsis. Fifteen patients had new-onset diarrhea in the 1st year with four having CMV[CE2] [CE2] antigen positivity, one with Clostridium difficile, and seven patients with diarrhea resolving with termination of mycophenolate. Four had Escherichia coli or Salmonella diarrhea which responded to oral antibiotics. One patient developed herpes zoster and another developed hepatic mucormycosis. Twelve patients developed sustained tremors and ten had severe headaches needing tricyclic antidepressants. Ten patients had episodes of leukopenia, eight of which resolved after temporary stoppage of valganciclovir and reduced dose of mycophenolate and two patients needed Granulocyte-colony stimulating factor therapy. Conclusions: This report covers the experience of 2 years and 55 patients. Mild side effects were noted in 30 patients after heart transplant. Side effects such as diarrhea, tremors, and headache were easily treated by clinical manipulation of drugs. Overall, 14 patients had significant bacterial or fungal or viral infections. Three patients died of sepsis ( first 15 days after transplant in 2 patients and 3–6 months in another).