title: A single-center retrospective clinicopathologic study of endomyocardial biopsies after heart transplant at Baskent University Hospital in Ankara, 1993-2014.
abstract: OBJECTIVE
  The purpose of this study was to investigate the frequency and prognostic importance of acute cellular rejection after heart transplant.
  
  
  METHODS
  All 84 heart transplant patients at our center from January 1993 to January 2014, including all 576 endomyocardial biopsies, were evaluated with retrospective review of clinical records and endomyocardial biopsies. Routine and clinically indicated endomyocardial biopsies after heart transplant were graded for acute cellular rejection (2005 International Society for Heart and Lung Transplantation Working Formulation). Survival analysis was performed using Kaplan-Meier method.
  
  
  RESULTS
  There were 61 male (73%) and 23 female recipients. Median age at heart transplant was 29 years (range, 1-62 y). Posttransplant early mortality rate was 17.9% (15 patients). In the other 69 patients, 23 patients died and 46 patients (66.7%) were alive at mean 69.3 ± 7.2 months after heart transplant. Mean follow-up was 35.4 ± 29.8 months (range, 0.07-117.5 mo). Mean 8.4 ± 4.2 endomyocardial biopsies (range, 1-19 biopsies) were performed per patient. Median first biopsy time was 7 days (range, 1-78 d). The frequency of posttransplant acute cellular rejection was 63.8% (44 of 69 patients) by histopathology; 86% patients experienced the first episode of acute cellular rejection within 6 months after transplant. There were 18 patients with acute cellular rejection ≥ grade 2R on ≥ 1 endomyocardial biopsy in 44 patients with acute cellular rejection. No significant difference was observed between survival rates of patients with grade 1R or ≥ grade 2R acute cellular rejection, or between survival rates of patients with or without diagnosis of any grade of acute cellular rejection. Acute cellular rejection was not related to any prognostic risk factor.
  
  
  CONCLUSIONS
  Acute cellular rejection had no negative effect on heart recipient long-term survival, but it was a frequent complication after heart transplant, especially within the first 6 months.
authors.affiliation: From the Department of Pathology, Başkent University Medical School, Ankara, Turkey.
authors.forename: Ayşen
authors.initials: A
authors.lastname: Terzi
authors.forename: Atilla
authors.initials: A
authors.lastname: Sezgin
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Tunca
authors.forename: Ebru
authors.initials: E
authors.lastname: Deniz
authors.forename: Ebru Şebnem
authors.initials: EŞ
authors.lastname: Ayva
authors.forename: Nihan
authors.initials: N
authors.lastname: Haberal Reyhan
authors.forename: Haldun
authors.initials: H
authors.lastname: Müderrisoğlu
authors.forename: Binnaz Handan
authors.initials: BH
authors.lastname: Özdemir
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D007111:Immunity, Cellular; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000276:immunology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult