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Cardiac transplantation is a method of choice in the treatment of patients with end-stage heart failure (HF) whose life expectancy, despite the optimal medical therapy is less than one year. Number of patiences with diabetes are increasing at alarming rates. Some studies have shown an increased risk of post-transplant infection, transplanted organ rejection, renal failure and mortality in diabetic recipients. A 38-year-old African American male patient with end-stage ischemic biventricular cardiomyopathy and diabetes mellitus type 1 with moderate chronic renal failure, was transplanted in August 2014. A few days following the transplantation his renal function continued to deteriorate and chronic haemodialysis was initiated. During the next four years, the regular heart biopsies showed no signs of acute cellular or humoral rejection and echocardiography showed normal graft function. In February 2018 the patient was listed for kidney transplantation. In April 2018 the patient presented with septic shock. Due to the severe eosinophilia combined with culture-negative severe sepsis, complete viral and parasitic serology was performed. All tests came back negative. Bone marrow aspiration showed only eosinophilia. Due to the sepsis of unknown origin, the patient was treated with broad-spectrum antibiotic therapy without an effective response to applied therapy. Despite of the all intensive care treatment, the patient died. Autopsy showed a pancarditis possibly caused by Trypanosoma cruzi or Toxoplasma gondii. In conclusion, cardiac transplantation can be performed in diabetic patients with chronic renal failure, but with significantly increased risk for further renal deterioration and even the need for chronic haemodialysis. [ABSTRACT FROM AUTHOR]

Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous group of lymphoid neoplasms associated with immunosuppression following solid organ transplantation or allogeneic hematopoietic stem cell transplantation. Mismatch for cytomegalovirus (CMV), such as when a seronegative recipient receives an organ from a seropositive donor, was shown to be associated with a seven-fold increase in PTLD. A 20-year-old male patient was admitted to the hospital due to back and abdominal pain. He had underwent a heart transplant 6 years ago due to postmyocarditic dilated cardiomyopathy and soon after the transplant, he had developed CMV pneumonitis. At examination, abdominal ultrasound showed multiple lesions of the liver, and patohystology of the lesion biopsy revealed PTLD, i.e. Non- Hodgkin's diffuse large B cell lymphoma, for which the patient received 8 cycles of chemotherapy (RCHOP protocol). Nine months after the first dose, the patient was admitted to the hospital due to simptoms of heart failure (NYHA IV) and echocardiography revealed significantly reduced cardiac function (LVEF 25%). Graft rejection was excluded with heart biopsy and it was concluded the etiology of heart failure was anthracycline (Doxorubicin) toxicity. Given the severity of the patient's condition, he was again listed for heart transplant, and ultimately, retransplanted. Eight years after the retransplant, the patient is in excellent overall condition. Heart transplant patients have about a 1- 6% risk to develop the PTLD. The incidence of chronic Doxorubicin cardiotoxicity is about 1.7%. This patient had developed both, but, fortunately, with timely and right therapy the outcome can be successful. [ABSTRACT FROM AUTHOR]