title: Multi-organ transplantation: is there a protective effect against acute and chronic rejection?
abstract: BACKGROUND
  Heart-lung transplantation (Tx) is known to offer a protective effect against acute cardiac rejection. This study was undertaken to evaluate acute and chronic heart and/or lung rejection in the setting of multiple-transplanted organs from the same donor compared with single-organ transplantation.
  
  
  METHODS
  Acute (treated rejection episodes of heart or lungs) and chronic (allograft vasculopathy in hearts and bronchiolitis obliterans syndrome [BOS] in lungs) rejection events were analyzed in 348 heart transplant (H) recipients, 24 heart-lung (HL) recipients, 82 double-lung (L) recipients and 8 heart-kidney (HK) recipients >18 years of age, who were transplanted between 1990 and 2002.
  
  
  RESULTS
  Survival at 3 years differed among groups as follows: HK, 100%; H, 82%; HL, 74%; and L, 70%. The probability of acute rejection within the first 3 months was higher in H recipients than in HL (81% vs 22%; p < 0.0001) or HK (81% vs 12%; p = 0.00009) recipients. Acute cardiac rejection occurred more frequently during the first 2 years in isolated H recipients compared with HL (2.8 vs 0.27 episodes; p < 0.0001) and HK (2.8 vs 0.54; p < 0.001) recipients. Acute lung rejection occurred more frequently in the first 2 years in L than HL (2.4 vs 1.0 episodes; p = 0.02) recipients. Chronic cardiac rejection (allograft vasculopathy) was more likely within 3 years after H compared with HL (32% vs 16%; p = 0.04) or HK (32% vs 0%; p = 0.14). The onset of chronic lung rejection (BOS) within 3 years was similar in HL and L recipients (39% vs 40%; p = 0.9).
  
  
  CONCLUSIONS
  Recipients of multiple organs from a single donor undergo less acute rejection of the heart or lungs compared with isolated heart or lung transplant recipients. Cardiac allograft vasculopathy is decreased significantly when cardiac transplantation is combined with a lung allograft. A lower incidence of cardiac allograft vasculopathy is observed when cardiac transplantation is combined with a renal allograft, and may prove statistically significant when more cases have been accumulated. These phenomena may result from immune modulation of the recipient by simultaneous transplant of disparate tissues or introduction of immune-modulating hematopoietic elements.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alabama, Birmingham, Alabama 35294-0006, USA. lpinderski@cardio.dom.uab.edu
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Pinderski
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: David
authors.initials: D
authors.lastname: McGiffin
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.forename: K Randall
authors.initials: KR
authors.lastname: Young
authors.forename: Katrina
authors.initials: K
authors.lastname: Smith
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
authors.forename: Jose A
authors.initials: JA
authors.lastname: Tallaj
authors.forename: Barry K
authors.initials: BK
authors.lastname: Rayburn
authors.forename: Ray
authors.initials: R
authors.lastname: Benza
authors.forename: George
authors.initials: G
authors.lastname: Zorn
authors.forename: Kevin
authors.initials: K
authors.lastname: Leon
authors.forename: Keith
authors.initials: K
authors.lastname: Wille
authors.forename: Mark
authors.initials: M
authors.lastname: Deierhoi
authors.forename: James F
authors.initials: JF
authors.lastname: George
mesh_terms: D000208:Acute Disease; D001989:Bronchiolitis Obliterans / Q000453:epidemiology; D002908:Chronic Disease; D003327:Coronary Disease / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D016027:Heart Transplantation / Q000276:immunology*; D016041:Heart-Lung Transplantation / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies