Metabolic abnormalities following heart transplantation in patients with idiopathic cardiomyopathy

Thiazolidinedione therapy in a patient with diabetes after cardiac transplantation

OBJECTIVE

To describe the successful use of a thiazolidinedione agent for the treatment of diabetes diagnosed after heart transplantation.

METHODS

We present a case report of a 51-year-old woman who underwent cardiac transplantation because of cardiomyopathy; diabetes developed 6 months later. Her clinical course and serial laboratory findings are documented as insulin therapy was initiated and subsequently transitioned to rosiglitazone during maintenance of the immunosuppressive regimen.

RESULTS

After rosiglitazone therapy was instituted, the patient's insulin dose was gradually tapered and eventually stopped. Target glycemic control was maintained without apparent aggravation of cardiac function or volume overload. No deleterious effects on other organ systems or interactions with the antirejection medications were noted during close follow-up.

CONCLUSION

Rosiglitazone may be safe and effective therapy for patients with posttransplantation diabetes. Rosiglitazone also helps to counteract the insulin-resistant state and reduces or eliminates the need for exogenous insulin. Further studies should attempt to confirm the usefulness of treatment with thiazolidinediones for patients with diabetes after organ transplantation.

Periodontal management of gingival overgrowth in the heart transplant patient: a case report

Heart transplant patients take several medications that could affect their periodontal health. Gingival overgrowth associated with cyclosporin (immunosuppressant agent) and nifedipine (calcium channel blocker) is well documented. Candidal infections often develop because of immune suppression. This report describes the clinical and histopathological changes in the gingival tissues of a heart transplant patient and their management. The gingival tissues exhibited pronounced enlargement. The gingivae were lobulated, and the surface of the lobulations was pebbly and granular. Biopsies showed lobules of fibrous connective tissue covered by stratified squamous epithelium. The outer surfaces were dotted with numerous smaller papillations. Candidal hyphae were present in the superficial layers of the epithelium. The extensive papillary lesions appear to be related to candidiasis and constitute a condition which is best designated as papillary stomatitis. Hyperplastic gingival tissues were excised, and the patient was placed on periodic maintenance. One-year postoperative follow-up showed minor gingival growth.