title: Severe cardiac allograft dysfunction without endomyocardial biopsy signs of cellular rejection: incidence and management.
abstract: Acute dysfunction of cardiac allograft without evidence of cellular rejection is a potentially fatal complication of heart transplantation that suggests a humoral origin. In clinical practice, humoral rejection (HR) is suspected when there is evidence of severe allograft dysfunction but endomyocardial biopsy (EMB) shows no evidence of cellular rejection. Between April 1991 and August 2003, 12 patients (2.74%) among 438 heart transplants displayed this condition. Time post-heart transplant (HT) was 21.3 +/- 24.7 months (range 2 to 72 months). Immunofluorescence studies using classic markers were negative. All patients were treated with methylprednisolone "bolus" and plasmapheresis until clinical recovery, after which their immunosuppressive regimens were modified. Eleven of the 12 patients recovered satisfactory allograft function. In this series the incidence of suspected HR was low. Unlike other studies, we observed HR not only soon but also even years after HT. Plasmapheresis seems to be an effective treatment.
authors.affiliation: Department of Pathology, CHU Juan Canalejo, As Xubias de Arriba 84, PC: 15006, A Coruña, Spain. veigabarreiro@canalejo.org
authors.forename: A
authors.initials: A
authors.lastname: Veiga Barreiro
authors.forename: M
authors.initials: M
authors.lastname: Crespo Leiro
authors.forename: N
authors.initials: N
authors.lastname: Doménech García
authors.forename: M J
authors.initials: MJ
authors.lastname: Paniagua
authors.forename: E
authors.initials: E
authors.lastname: Vázquez Martul
authors.forename: M
authors.initials: M
authors.lastname: González Cuesta
authors.forename: C
authors.initials: C
authors.lastname: Ramírez
authors.forename: A
authors.initials: A
authors.lastname: Juffé Stein
authors.forename: A
authors.initials: A
authors.lastname: Castro Beiras
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000628:therapy; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000276:immunology* / Q000473:pathology; D016896:Treatment Outcome