title: Myocardial ischemic-fibrotic injury after human heart transplantation is associated with increased progression of vasculopathy, decreased cellular rejection and poor long-term outcome.
abstract: OBJECTIVE
  We sought to assess the influence of peritransplant ischemia and fibrosis on the development of allograft vasculopathy, acute cellular rejection and long-term outcome.
  
  
  BACKGROUND
  Allograft vasculopathy is a common long-term complication of cardiac transplantation. One of the potential risk factors is peritransplant allograft ischemia.
  
  
  METHODS
  One hundred forty heart transplant recipients had baseline and one-year intravascular ultrasound analysis done to assess the progression of allograft vasculopathy. Serial endomyocardial biopsies were evaluated for cellular rejection, vascular rejection, ischemia and fibrosis. Based on histology, patients were classified into one of the following groups: nonischemic (n = 32), ischemia (n = 24), fibrosis (n = 62) or vascular rejection (n = 22). Three-color flow cytometry crossmatching (FCXM) was used to assess donor-specific human lymphocyte antigens (HLA) sensitization. Long-term outcome of patients in each group was assessed by estimating incidence of graft failure or deaths over a seven-year follow up.
  
  
  RESULTS
  Patients in the fibrosis group had the lowest incidence of donor-specific HLA sensitization (40%, p = 0.008) and lowest average episodes of cellular rejection (1.7 +/- 1.4, p = 0.04), but they had increased coronary vasculopathy progression (change in coronary intimal thickness = 0.59 +/- 0.28 mm, p < 0.0001) and poor seven-year event-free survival (49%, p = 0.01).
  
  
  CONCLUSIONS
  The development of fibrosis after cardiac transplantation is associated with advanced coronary vasculopathy, although a low incidence of acute cellular rejection is noted, suggesting the presence of nonimmune mechanisms in mediating the pathogenesis of allograft vasculopathy.
authors.affiliation: Department of Cardiology, Kaufman Heart Failure Center, Cleveland, Ohio, USA. yamanim@ccf.org
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: Yamani
authors.forename: Showkat A
authors.initials: SA
authors.lastname: Haji
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Norman B
authors.initials: NB
authors.lastname: Ratliff
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Ashraf
authors.initials: A
authors.lastname: Abdo
authors.forename: Tim
authors.initials: T
authors.lastname: Crowe
authors.forename: Michelle
authors.initials: M
authors.lastname: Secic
authors.forename: Patrick
authors.initials: P
authors.lastname: McCarthy
authors.forename: James B
authors.initials: JB
authors.lastname: Young
mesh_terms: D000293:Adolescent; D000328:Adult; D017023:Coronary Angiography; D018450:Disease Progression; D004719:Endomyocardial Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis; D013995:Time; D014019:Tissue Donors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality
chemical_list: D006680:HLA Antigens