title: The changing pattern of humoral rejection in cardiac transplant recipients.
abstract: BACKGROUND
  Most humoral rejection (HR) episodes occur early after cardiac transplantation and are associated with hemodynamic compromise and poor prognosis. Late cases of HR (>6 months after transplant) have been reported. We examined the differences in clinical characteristics and outcomes in patients presenting with HR in the early (<6 months) and late transplant periods.
  
  
  METHODS
  A retrospective chart review was performed of all cases of HR at a single large transplant center from January 1, 1995 to March 1, 2006.
  
  
  RESULTS
  A total of 37 adult transplants had biopsy-proven HR; 13 patients had early HR and 24 patients had HR a mean of 5 yr after transplantation (range, 7 months to 17 yrs). Treatment for HR included plasmapheresis, cyclophosphamide, and rituximab. The age of the early and late humoral rejecters was similar (58+/-14 vs. 50+/-14 yrs; P=0.12). There was a trend toward more women in the early HR group (54% vs. 33%). Use of left ventricular assist devices was similar (38% vs. 33%). Early rejecters were more likely to have positive cross-matches (46% vs. 8%; P<0.01). Patients with late HR had a coexistent diagnosis of malignancy, or significant recent infection in 50% vs. 8% for early HR, suggesting an activation of a nonhuman leukocyte antigen antibody-mediated immune response to an acute illness. One-year survival after the diagnosis of HR was 78% for the both groups (P=NS).
  
  
  CONCLUSIONS
  Humoral rejection occurs now more frequently in patients with remote transplants and is commonly associated with the presence of malignancy or infection.
authors: Division of Cardiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY 10032, USA.
authors: Khalid
authors: K
authors: Almuti
authors: Jennifer
authors: J
authors: Haythe
authors: Edward
authors: E
authors: Dwyer
authors: Silviu
authors: S
authors: Itescu
authors: Elizabeth
authors: E
authors: Burke
authors: Philip
authors: P
authors: Green
authors: Charles
authors: C
authors: Marboe
authors: Donna
authors: D
authors: Mancini
mesh_terms: D000328:Adult; D000368:Aged; D000917:Antibody Formation / Q000502:physiology; D015935:Complement C4b / Q000378:metabolism; D004730:Endothelium, Vascular / Q000276:immunology / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d