title: Acute cellular rejection the first year after heart transplantation and its impact on survival: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010.
abstract: Acute cellular rejection (ACR) the first year after heart transplantation (HT) and its impact on survival was investigated. All 215 HT patients at our centre 1988-2010, including 219 HTs and 2990 first-year endomyocardial biopsies (EMBs), were studied. 'Routine' EMBs obtained 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40 and 52 weeks after HT, and 'additional clinically indicated' (ACI) EMBs, were graded according to the 1990-ISHLT-WF. The frequency and severity of first-year ACRs was low, with 6.5% of routine EMBs and 14.1% of ACI EMBs showing ACR ≥ grade 2. Proportionally more (P < 0.05) first-year ACRs ≥ grade 2 were found among EMBs in HTs performed during 1988-1999 (9.6%) than 2000-2010 (5.5%), EMBs performed during 16-52 weeks (8.8%) than 1-12 weeks (6.3%) after HT, EMBs in HTs with paediatric (11.3%) than adult (7.1%) donors, and EMBs in sex-mismatched (10.4%) than sex-matched (6.3%) HTs. Five- and ten-year survival was furthermore lower (P < 0.05) among HTs with ≥ 1 compared with 0 first-year ACRs ≥ grade 3A/3B (82% vs. 92% and 69% vs. 82%, respectively). Ten-year survival was 74% compared with 53% in the ISHLT registry. In conclusion, our results indicate that first-year ACRs ≥ grade 3A/3B affect long-term survival. We believe frequent first-year EMBs may allow early ACR detection and continuous immunosuppressive adjustments, preventing low-grade ACRs from progressing to ACRs ≥ grade 3A/3B, thereby improving survival.
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; The Haemodynamic Lab, The Clinic for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Söderlund
authors.forename: Jenny
authors.initials: J
authors.lastname: Öhman
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
authors.forename: Thomas
authors.initials: T
authors.lastname: Higgins
authors.forename: Björn
authors.initials: B
authors.lastname: Kornhall
authors.forename: Leif
authors.initials: L
authors.lastname: Johansson
authors.forename: Göran
authors.initials: G
authors.lastname: Rådegran
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: acute rejection; cardiac transplantation; first year