Late rejection occurred in recipients who experienced acute cellular rejection within the first year after heart transplantation.
Serial endomyocardial biopsies (EMBs) are scheduled even several years after heart transplantation (HTx) to monitor for late rejection (LR). However, repeated EMBs are associated with an increased risk for fatal complications and decrease the quality of life of the recipient. We retrospectively analyzed clinical data from 42 adult recipients who had received HTx and were followed > 1 year at the University of Tokyo Hospital. Five recipients experienced LR at 1130 ± 157 days after HTx, and all 5 had experienced acute cellular rejection (ACR) with ISHLT grade ≥ 2R within the first year, which was treated with methylprednisolone pulse therapy (sensitivity, 1.000; specificity, 0.7027). Logistic regression analyses demonstrated that positive panel reactive antibody (PRA) was the only significant predictor for LR among all parameters at 1 year after HTx (P = 0.020, odds ratio 24.00). Among the 5 recipients with LR, LR occurred earlier in the two PRA positive recipients than in those with a negative PRA (981 ± 12 versus 1230 ± 110 days, P = 0.042). Among the perioperative parameters, gender mismatch [n = 13 (31%)] was the only significant predictor for ACR within the first year in logistic regression analyses (P = 0.042, odds ratio 4.200). In conclusion, the current schedule of serial EMBs should perhaps be reconsidered for recipients without any history of ACR within the first year due to their lower risk of LR.
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo.
Teruhiko
T
Imamura
Koichiro
K
Kinugawa
Daisuke
D
Nitta
Takeo
T
Fujino
Toshiro
T
Inaba
Hisataka
H
Maki
Masaru
M
Hatano
Osamu
O
Kinoshita
Kan
K
Nawata
Atsushi
A
Yao
Shunei
S
Kyo
Minoru
M
Ono
D000328:Adult; D001706:Biopsy; D004699:Endocardium / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006333:Heart Failure / Q000473:pathology* / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors