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Quản lý các bệnh nhiễm trùng cơ hội sau khi cấy ghép tim IE thử nghiệm-Gene, PCR, IgM IgM IgM IgM kháng nguyên nước tiểu, x ray Ziehl-Neelson Brain CT x tia X quang, IFT, CFT, IgA, IgM Direct X quang não CT điều trị Gancyclovir, nếu nghiêm trọng thêm kháng thể | EDUCATION IN HEART Table 7.8 Management of opportunistic infections after cardiac transplantation Organism Test Treatment Cytomegalovirus IE-Gene PCR IgM Gancyclovir if severe additional CMV antibodies Herpes simplex virus IgM Aciclovir Varicella-zoster virus fcM Aciclovir Hepatitis B virus fcM Lamivudine Legionella species Urine antigen x ray Erythromycin Mycobacterium tuberculosis Ziehl-Neelson Rifampicin isoniazid myambutol Nocardia asteroides Brain CT Sulfamethoxazole trimethoprim Pneumocystis carinii x ray Sulfamethoxazole trimethoprim Toxoplasma gondii X ray IFT CFT IgA IgM Pyrimethamine sulfadiazine folic acid Candida albicans Direct Fluconazole itraconazole Aspergillus fumigatus X ray Itraconazole amphotericin B flucytosine Cryptococcus neoformans Brain CT Itraconazole amphotericin B flucytosine or fluconazole Listeria monocytogenes CNS ampicillin gentamycin CMV cytomegalovirus CT computed tomography IFT immunofluoresence test CFT complement fixation test. conventional preventative measures have limited effects. Several pharmacological agents including the calcium channel blocker diltiazem 65 and statins such as pravastatin14 or simvastatin w66 have been shown to be effective. Malignancies Malignancies play a major role as cause of death after cardiac transplantation. In the long term course after cardiac transplantation the risk of malignancies occurring is 1-2 per year. This risk is 10-100 fold higher than the risk in an age matched control population. Malignant tumours of the skin and lymphomas are the most frequent types but any solid organ tumour may occur. The incidence of post-transplant lymphoproliferative disorder with a cyclosporine based immunosuppressive regimen is estimated to be around 2-4 67 www.ctstransplant.org and is a frequent and often fatal complication of organ transplantation. It most often results from an Epstein-Barr virus transformed B cell clone which expresses B cell surface markers such as CD20. While these lymphomas may respond
