Repetitive nontreated episodes of grade 1B or 2 acute rejection impair long-term cardiac graft function.
BACKGROUND
Episodes of grade 1B or 2 acute heart rejection are usually not treated, and most of them resolve spontaneously.


METHODS
With the aim to assess long-term outcome in patients with repetitive nontreated episodes of low-grade (1B, 2) acute rejection, we have studied 141 heart transplant recipients in whom the evolutive pattern of acute rejection during the first 6 months after transplantation could be determined.


RESULTS
Forty-four patients (31%) had only grade 0 or 1A acute rejection episodes (pattern A); 23 patients (16%) had three or more episodes of grade 1B or 2 acute rejection without 3A or more advanced rejection (pattern B); 48 patients (34%) had one or two episodes of grade 3A, 3B, or 4 acute rejection only during the first 6 months after transplantation (pattern C); and 26 patients (19%) had three or more episodes of grade 3A, 3B, or 4 acute rejection (pattern D). Overall mortality was 11%, 26%, 19%, and 46% for patients with patterns A, B, C, and D, respectively. No difference was found among patterns with regard to incidence of graft atherosclerosis. Left ventricular ejection fraction at 1 year after transplantation was significantly lower (p < 0.05) for patients with pattern B (50% +/- 5% versus 59% +/- 7%, 59% +/- 11%, and 56% +/- 6% for patterns A, C, and D, respectively); cardiac index also was lower for patients with pattern B than for those with pattern A (3.6 +/- 0.6 versus 4.1 +/- 0.6 L/min/m2, p < 0.05).


CONCLUSIONS
Although mortality was higher for patients with more severe episodes of acute rejection, only repetitive nontreated episodes of grade 1B or 2 rejection significantly impaired long-term graft function.
Anguita
M
M
Department of Cardiology, Hospital Universitario Reina Sofía, University of Códoba, Spain.
López-Rubio
F
F
Arizón
J M
JM
Latre
J M
JM
Casares
J
J
López-Granados
A
A
Mesa
D
D
Giménez
D
D
Torres
F
F
Concha
M
M
D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality; D006321:Heart / Q000503:physiopathology*; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications