Asymptomatic Antibody-mediated Rejection After Heart Transplantation Predicts Poor Outcomes

Overview

Journal J Heart Lung Transplant

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2009 May 7

PMID 19416767

Citations 39

Authors

Grace W Wu

Jon A Kobashigawa

Michael C Fishbein

Jignesh K Patel

Michelle M Kittleson

Elaine F Reed

Krista K Kiyosaki

Abbas Ardehali

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Microcirculatory Dysfunction and Its Role in Diagnosing Acute Rejection in Pediatric Heart Transplantation: A Pilot Study.

Rivero-Santana B, Balbacid-Domingo E, Abelleira-Pardeiro C, Labrandero de Lera C, Arreo Del Val V, Jimenez-Valero S Diagnostics (Basel). 2025; 15(5).

PMID: 40075793 PMC: 11899627. DOI: 10.3390/diagnostics15050545.

Heart transplantation and biomarkers: a review about their usefulness in clinical practice.

Martini L, Mandoli G, Pastore M, Pagliaro A, Bernazzali S, Maccherini M Front Cardiovasc Med. 2024; 11:1336011.

PMID: 38327491 PMC: 10847311. DOI: 10.3389/fcvm.2024.1336011.

The Clinical Utility of Post-Transplant Monitoring of Donor-Specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report With Guideline Statements for Clinical Practice.

van den Broek D, Meziyerh S, Budde K, Lefaucheur C, Cozzi E, Bertrand D Transpl Int. 2023; 36:11321.

PMID: 37560072 PMC: 10408721. DOI: 10.3389/ti.2023.11321.

Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center.

Chang D, Youn J, Dilibero D, Patel J, Kobashigawa J Int J Heart Fail. 2022; 3(1):15-30.

PMID: 36263111 PMC: 9536714. DOI: 10.36628/ijhf.2020.0034.

A Review of Biomarkers of Cardiac Allograft Rejection: Toward an Integrated Diagnosis of Rejection.

Coutance G, Desire E, Duong van Huyen J Biomolecules. 2022; 12(8).

PMID: 36009029 PMC: 9405997. DOI: 10.3390/biom12081135.

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