title: Hemodynamics during humoral rejection events with total versus standard orthotopic heart transplantation.
abstract: OBJECTIVE
  We hypothesized that total orthotopic heart transplantation (TOHT) improves humoral rejection hemodynamics compared with biatrial transplantation or standard orthotopic heart transplantation (SOHT).
  
  
  METHODS
  We reviewed 1942 biopsies from 134 patients (pts) and right heart catheterization data obtained at endomyocardial biopsy. Biopsies that displayed humoral rejection by histological findings and positive immunofluorescence for immunoglobulins and complement were analyzed. Patients with pacemakers, atrial fibrillation or beta-blocker therapy at the time of biopsy were excluded. Thirty-two pts after TOHT and 22 after SOHT matching these criteria were identified.
  
  
  RESULTS
  Demographic data, underlying disease, pretransplant hemodynamics, and donor demographics were similar. Cardiac output and index were higher in the total orthotopic group (5.9+/-1.1 vs 5.1+/-1.4 L/min, p=0.027; 3.3+/-0.5 vs 2.8+/-0.6 L/min/m2, p=0.016). Right atrial and pulmonary capillary wedge pressure were lower after TOHT (7+/-3 vs 11+/-5 mmHg, p<0.001; 13+/-4 vs 16+/-5 mmHg, p=0.035). Pulmonary pressures, pulmonary vascular resistance and heart rate were similar.
  
  
  CONCLUSIONS
  TOHT offers improved hemodynamics during humoral rejection as evidenced by higher cardiac output and index with lower right atrial and pulmonary capillary wedge pressures. Future studies must examine the potential benefits of TOHT during combined cellular and humoral rejection events.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Essen, Essen, Germany.
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
authors.forename: Dov
authors.initials: D
authors.lastname: Freimark
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanche
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000917:Antibody Formation; D001706:Biopsy; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002302:Cardiac Output; D015986:Confounding Factors, Epidemiologic; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016016:Proportional Hazards Models; D011652:Pulmonary Circulation; D011667:Pulmonary Veins / Q000601:surgery; D011669:Pulmonary Wedge Pressure; D014181:Transplantation Immunology; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014655:Vascular Resistance; D014684:Venae Cavae / Q000601:surgery