BACKGROUND: Antibody-mediated rejection (AMR) has been associated with poor outcome after heart transplantation. The diagnosis of AMR usually includes endomyocardial biopsy findings of endothelial cell swelling, intravascular macrophages, C4d+ staining, and associated left ventricular dysfunction. The significance of AMR findings in biopsy specimens of asymptomatic heart transplant patients (normal cardiac function and no symptoms of heart failure) is unclear. METHODS: Between July 1997 and September 2001, AMR was found in the biopsy specimens of 43 patients. Patients were divided into 2 groups: asymptomatic AMR (AsAMR, n = 21) and treated AMR (TxAMR with associated left ventricular dysfunction, n = 22). For comparison, a control group of 86 contemporaneous patients, without AMR, was matched for age, gender, and time from transplant. Outcomes included 5-year actuarial survival and development of cardiac allograft vasculopathy (CAV). Patients were considered to have AMR if they had > or = 1 endomyocardial biopsy specimen positive for AMR. RESULTS: The 5-year actuarial survival for the AsAMR (86%), TxAMR (68%), and control groups (79%) was not significantly different (p = 0.41). Five-year freedom from CAV (> or = 30% stenosis in any vessel) was AsAMR, 52%; TxAMR, 68%; and control, 79%. Individually, freedom from CAV was significantly lower in the AsAMR group compared with the control group (p = 0.02). There was no significant difference between AsAMR vs TxAMR and TxAMR vs control for CAV. CONCLUSIONS: Despite comparable 5-year survival with controls after heart transplantation, AsAMR rejection is associated with a greater risk of CAV. Trials to treat AsAMR to alter outcome are warranted.
BACKGROUND: Antibody-mediated rejection (AMR) has been associated with poor outcome after heart transplantation. The diagnosis of AMR usually includes endomyocardial biopsy findings of endothelial cell swelling, intravascular macrophages, C4d+ staining, and associated left ventricular dysfunction. The significance of AMR findings in biopsy specimens of asymptomatic heart transplant patients (normal cardiac function and no symptoms of heart failure) is unclear. METHODS: Between July 1997 and September 2001, AMR was found in the biopsy specimens of 43 patients. Patients were divided into 2 groups: asymptomatic AMR (AsAMR, n = 21) and treated AMR (TxAMR with associated left ventricular dysfunction, n = 22). For comparison, a control group of 86 contemporaneous patients, without AMR, was matched for age, gender, and time from transplant. Outcomes included 5-year actuarial survival and development of cardiac allograft vasculopathy (CAV). Patients were considered to have AMR if they had > or = 1 endomyocardial biopsy specimen positive for AMR. RESULTS: The 5-year actuarial survival for the AsAMR (86%), TxAMR (68%), and control groups (79%) was not significantly different (p = 0.41). Five-year freedom from CAV (> or = 30% stenosis in any vessel) was AsAMR, 52%; TxAMR, 68%; and control, 79%. Individually, freedom from CAV was significantly lower in the AsAMR group compared with the control group (p = 0.02). There was no significant difference between AsAMR vs TxAMR and TxAMR vs control for CAV. CONCLUSIONS: Despite comparable 5-year survival with controls after heart transplantation, AsAMR rejection is associated with a greater risk of CAV. Trials to treat AsAMR to alter outcome are warranted.
Authors: Carlos A Vieira; Avinash Agarwal; Benita K Book; Richard A Sidner; Christopher M Bearden; Howard M Gebel; Anthony L Roggero; Naomi S Fineberg; Timothy Taber; Michael A Kraus; Mark D Pescovitz Journal: Transplantation Date: 2004-02-27 Impact factor: 4.939
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Authors: A Herskowitz; L M Soule; K Ueda; F Tamura; W A Baumgartner; A M Borkon; B A Reitz; S C Achuff; T A Traill; K L Baughman Journal: J Heart Transplant Date: 1987 May-Jun
Authors: E H Hammond; R L Yowell; S Nunoda; R L Menlove; D G Renlund; M R Bristow; W A Gay; K W Jones; J B O'Connell Journal: J Heart Transplant Date: 1989 Nov-Dec
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Authors: N M Valenzuela; L Hong; X-Da Shen; F Gao; S H Young; E Rozengurt; J W Kupiec-Weglinski; M C Fishbein; E F Reed Journal: Am J Transplant Date: 2012-12-27 Impact factor: 8.086
Authors: Hideki Kitahara; Kozo Okada; Shigemitsu Tanaka; Hyoung-Mo Yang; Kojiro Miki; Yuhei Kobayashi; Takumi Kimura; Helen Luikart; Paul G Yock; Alan C Yeung; Peter J Fitzgerald; Kiran K Khush; William F Fearon; Yasuhiro Honda Journal: J Heart Lung Transplant Date: 2016-03-10 Impact factor: 10.247