Immune Tolerance After Total Lymphoid Irradiation for Heart Transplantation: Immunosuppressant-free Survival for 8 Years

A 51-year-old African American man underwent orthotopic heart transplantation in 1995 for post-viral cardiomyopathy. Refractory, rejection occurred, and he subsequently required total lymphoid irradiation to prevent further rejection. Disseminated Mycobacterium avium complex developed in 2000, and the patient decided to discontinue all drugs after the antibiotics caused intolerable medication side effects. The patient did not subsequently die of rejection, and he was discovered to have profound Suppression of several lymphocytes subsets, presumably from the previous total lymphoid irradiation. This induced immunotolerance appears to have enabled his prolonged immunosuppressant-free survival. J Heart Lung Transplant 2009; 28:743-5. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.