title: Right ventricular dysfunction predicts poor outcome following hemodynamically compromising rejection.
abstract: BACKGROUND
  Hemodynamically compromising rejection (HCR) is a major cause of mortality and morbidity after heart transplantation. Right ventricular (RV) function is a strong predictor of outcome in patients with heart failure and myocarditis. The objective of the current study is to determine whether RV dysfunction predicts event-free survival in patients with HCR.
  
  
  METHODS
  Medical records of 548 heart transplant patients followed at Stanford University between January 1998 and January 2007 were reviewed. HCR was defined as a rejection episode requiring hospitalization for heart failure. Univariate and multivariate analyses were performed to identify risk factors for death or retransplantation at 1 year.
  
  
  RESULTS
  HCR occurred in 71 patients (12.9%). Death or retransplantation at 1 year occurred in 28 patients (39%). Univariate analysis identified non-cellular rejection (odds ratio [OR] = 3.20, p = 0.021), the need for inotropic support (OR = 4.80, p = 0.007), RV dysfunction (OR = 4.63, p = 0.006), left ventricular ejection fraction (OR = 0.941, p = 0.031) and acute renal failure (OR = 3.82, p = 0.010) as predictors of death or retransplantation at 1 year. Multivariate analysis identified RV dysfunction (OR = 4.80, p = 0.007) and the need for inotropic support (OR = 5.00, p = 0.009) as predictors of death or retransplantation at 1 year.
  
  
  CONCLUSIONS
  In the modern era of immunosuppression, HCR remains a major complication after heart transplantation. RV dysfunction was identified as a novel risk factor for death or retransplantation following HCR.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California 94305-5406, USA. fhaddad@cvmed.stanford.edu
authors.forename: François
authors.initials: F
authors.lastname: Haddad
authors.forename: Patrick
authors.initials: P
authors.lastname: Fisher
authors.forename: Michael
authors.initials: M
authors.lastname: Pham
authors.forename: Gerald
authors.initials: G
authors.lastname: Berry
authors.forename: Dana
authors.initials: D
authors.lastname: Weisshaar
authors.forename: Suman
authors.initials: S
authors.lastname: Kuppahally
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
authors.forename: Tobias
authors.initials: T
authors.lastname: Deuse
authors.forename: Sean
authors.initials: S
authors.lastname: Virani
authors.forename: William
authors.initials: W
authors.lastname: Fearon
authors.forename: Hannah
authors.initials: H
authors.lastname: Valantine
authors.forename: Sharon
authors.initials: S
authors.lastname: Hunt