New, improved immunosuppression regimen for heart transplant patients

The regimen of antirejection drugs taken by heart transplant patients hasn't changed much in 25 years. The standard immunosuppressants are calcineurin inhibitors-drugs such as cyclosporine and tacrolimus. But because calcineurin inhibitors cause kidney dysfunction, 10% of patients need hemodialysis or a kidney transplant within 5 to 10 years of heart transplant, researchers said. And 50% of patients develop coronary artery disease (CAD) within 10 years of transplant, leading to a second heart transplant or death.

Researchers at the Mayo Clinic studied 78 heart transplant patients over 4 years. The patients spent 6 months on calcineurin inhibitors, then were gradually transitioned to sirolimus, an immunosuppressant with no calcineurin inhibition activity. This strategy helped improve kidney function and reduce the development of CAD without raising the heart rejection rate or affecting heart function.

The findings were reported at the recent meeting of the International Society for Heart & Lung Transplantation in San Francisco, Calif.

Craniectomy may help children with traumatic brain injury

Although often considered a last resort, decompressive craniectomy may help children with traumatic brain injury, according to results of a study reported at the recent American Association of Neurological Surgeons' meeting in Washington, D.C. Removing a section of bone from the skull lets the brain expand, reducing intracranial pressure (ICP) and improving cerebral perfusion.

Researchers looked at records of 23 pediatric patients treated with decompressive craniectomy between January 1995 and April 2006. Postoperative control of ICP was achieved in 19 patients. The mean patient age at the time of craniectomy was about 12 years. Seven patients died during or after surgery. Thirteen of the surviving patients recovered well enough to resume school. Of the seven surviving patients who are now over age 18, three are living independently and four are or have been employed.

Overall, researchers found that 65% of patients receiving craniectomy had favorable outcomes (defined as good recovery or moderate disability) and 9% had severe disability on long-term follow-up. Researcher Jay Jagannathan, MD, of the University of Virginia Health Sciences Center, said that craniectomy can help control ICP in children with traumatic brain injury and may help them achieve a reasonable quality of life.