Right ventricular dysfunction predicts poor outcome following hemodynamically compromising rejection.
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.
Haddad
François
F
Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California 94305-5406, USA. fhaddad@cvmed.stanford.edu
Fisher
Patrick
P
Pham
Michael
M
Berry
Gerald
G
Weisshaar
Dana
D
Kuppahally
Suman
S
Vrtovec
Bojan
B
Deuse
Tobias
T
Virani
Sean
S
Fearon
William
W
Valantine
Hannah
H
Hunt
Sharon
S