title: [Mid- and long-term acute cardiac allograft rejection: clinical observation of 14 patients].
abstract: OBJECTIVE
  To analyze the clinical features of mid- and long-term acute cardiac allograft rejection to improve the long-term clinical outcomes of the patients.
  
  
  METHODS
  Fourteen recipients (11 males and 3 females) underwent orthotopic heart transplantation with standard immunosuppressive therapy protocols (3 cases) or induction therapy protocols (11 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as the maintenance immunosuppressive regimen. Acute graft rejection episodes occurred within 3 to 6 months in 1 case, within 6 months to 1 year in 3 cases, within 1 to 2 years in 3 cases, within 2 to 5 years in 6 cases, and above 5 years in 1 case.
  
  
  RESULTS
  No significant difference was found in the incidence of late heart rejection between the patients receiving the two immunosuppressive therapy protocols. Immunosuppressants were withdrawn or spared in 8 recipients due to different causes. Nine recipients with steroid-sensitive acute cardiac allograft rejection were treated with steroid-pulse therapy, while the other 5 were treated with a short course of polyclonal antithymocyte antibodies because of steroid-resistant acute rejection; in 11 cases, azathioprine was converted to mycophenolate mofetil. Four of the 5 late deaths occurred in the recipients with steroid-resistant rejection. The surviving recipients had a good quality of life, and no recurrent episodes of rejection or infection were observed in the follow-up period.
  
  
  CONCLUSIONS
  Late acute cardiac allograft rejection is associated mainly with patient compliance but not with early immunosuppressive therapy protocols. The episodes are rather severe and should be timely treated with steroid pulses or polyclonal antithymocyte antibodies.
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China. drhxs@163.com
authors.forename: Xue-Shan
authors.initials: XS
authors.lastname: Huang
authors.forename: Dao-Zhong
authors.initials: DZ
authors.lastname: Chen
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D016572:Cyclosporine; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D016572:Cyclosporine; D009173:Mycophenolic Acid