New-onset graft dysfunction after heart transplantation--incidence and mechanism-related outcomes.
BACKGROUND
Graft dysfunction (GD) after heart transplantation (HTx) is a major cause of morbidity and mortality. The impact of different pathophysiologic mechanisms on outcome is unknown. In this large, single-center study we aimed to assess the incidence of GD and compare the outcomes with different histopathologic mechanisms of rejection.


METHODS
We analyzed a data set of 1,099 consecutive patients after their HTx at Columbia University Medical Center between January 1994 and March 2008, and identified all patients hospitalized with new-onset GD. Based on the histopathologic data, patients were divided into GD-unexplained (Group-GD-U), GD-antibody-mediated rejection (Group-GD-AMR), GD-cardiac allograft vasculopathy (Group-GD-CAV) and GD-acute cellular rejection (Group-GD-ACR) groups. We compared the in-hospital and 3-, 6- and 12-month mortality across these groups using the chi-square test. We also compared the 3-, 6- and 12-month survival curves across groups using the log-rank test.


RESULTS
Of 126 patients (12%) identified with GD, complete histology data were available for 100 patients. There were 21, 20, 27 and 32 patients identified in Group-GD-U, Group-GD-AMR, Group-GD-CAV and Group-GD-ACR, respectively. The in-hospital mortality rates were 52%, 20%, 15% and 6%, respectively. The in-hospital mortality rate was significantly higher in Group-GD-U compared with all other groups (p = 0.0006). The 3-, 6- and 12-month survival rate was also significantly lower in Group-GD-U compared with all other groups.


CONCLUSIONS
A significant proportion of patients presenting with new-onset GD have unexplained histopathology. Unexplained GD is associated with a significantly higher mortality rate. New diagnostic tools are necessary to better understand and detect/predict this malignant phenotype.
Shahzad
Khurram
K
Department of Medicine, Division of Cardiology, Columbia University, New York, New York 10032, USA.
Aziz
Quratul Ain
QA
Leva
Jean-Paul
JP
Cadeiras
Martin
M
Ho
Eric K
EK
Vlad
George
G
Vasilescu
E Rodica
ER
Latif
Farhana
F
Sinha
Anshu
A
Burke
Elizabeth
E
Addonizio
Linda J
LJ
Restaino
Susan W
SW
Marboe
Charles C
CC
Suciu-Foca
Nicole
N
Naka
Yoshifumi
Y
Mancini
Donna
D
Deng
Mario C
MC
D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000503:physiopathology* / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D012189:Retrospective Studies
D000888:Antibodies, Anti-Idiotypic; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D020097:Natriuretic Peptide, Brain