title: Morbidity risk factors in human cardiac transplantation. Histoincompatibility and protracted graft ischemia entail high risk of rejection and infection.
abstract: Data from the first 103 human heart transplantations performed on 100 recipients (aged 14-62 years) at a single center from November 1983 to January 1990 were analyzed in order to detect morbidity-causing risk factors. Cumulative one- and five-year graft survival was 82% and 68%. Multivariate analysis revealed three independent risk factors for early rejection, viz. HLA-DR and HLA-B mismatches and no prior cardiac surgery. Graft ischemic time exceeding 71 min was an independent risk factor for rejection, especially for moderate or severe events, and for infection. HLA-DR mismatch was an independent risk factor for moderate and severe rejection events and for infections. Finally, patients operated on because of end-stage ischemic heart disease were at significantly higher risk of rejection than those with other cardiac disorders. The study has several implications: Prospective tissue typing for cardiac transplantation and selection of donors may have an impact on graft function: Damage to the graft by prolonged ischemia may be reduced by improved organ preservation.
authors.affiliation: Department of Pathology, Ullevål Hospital, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Foerster
authors.forename: M
authors.initials: M
authors.lastname: Abdelnoor
authors.forename: O
authors.initials: O
authors.lastname: Geiran
authors.forename: H
authors.initials: H
authors.lastname: Lindberg
authors.forename: S
authors.initials: S
authors.lastname: Simonsen
authors.forename: E
authors.initials: E
authors.lastname: Thorsby
authors.forename: T
authors.initials: T
authors.lastname: Frøysaker
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003586:Cytomegalovirus Infections; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D015235:HLA-B Antigens / Q000032:analysis; D006684:HLA-DR Antigens / Q000032:analysis; D016027:Heart Transplantation / Q000009:adverse effects*; D006648:Histocompatibility; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011020:Pneumonia, Pneumocystis / Q000209:etiology; D012307:Risk Factors; D013203:Staphylococcal Infections; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors
chemical_list: D015235:HLA-B Antigens; D006684:HLA-DR Antigens