| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1996;94:1334-1338.)
© 1996 American Heart Association, Inc.
Articles |
Natural Course of Moderate Cardiac Allograft Rejection (International Society for Heart Transplantation Grade 2) Early and Late After Transplantation
the Division of Cardiology (H.P.B.-La R., G.S., F.F., W.K.) and the Department of Pathology (J.S.), University Hospital, Zurich, Switzerland.
Correspondence to Dr H.P. Brunner-La Rocca, Division of Cardiology, Department of Internal Medicine, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland.
Background The significance of International Society for Heart Transplantation (ISHT) grade 2 cardiac allograft rejection has been questioned, and the medical community is not in complete agreement as to its clinical management. We therefore retrospectively analyzed the follow-up of all available endomyocardial biopsy samples obtained from 161 transplant patients since introduction of the ISHT nomenclature at our institution.
Methods and Results Of 2868 biopsies performed 3 days to 8.9 years after transplantation, 420 biopsies had no follow-up or were preceded by intensified immunosuppression and were excluded from analysis. Of the remaining 2448 biopsies, 374 (15.3%) were repeat biopsies performed 7 to 10 days after prior ISHT 2 rejection without change of treatment. Of these, 70 (18.7%) had progressed to 
ISHT 3A, whereas 82 (21.9%) remained unchanged and 222 (59.4%) resolved. In contrast, follow-up of 2074 biopsies with lower-grade rejection showed graft rejection classified as ISHT 3A in 153 (7.4%), ISHT 2 in 240 (11.6%), and 
ISHT 1B in 1681 (81.1%) biopsy samples (P<.0001). In univariate analysis, the odds ratio (OR) of graft rejection ISHT 3A after ISHT 2 rejection was 2.89. Other univariate predictors of rejection ISHT 3A were time after transplantation (OR=0.96 per month, P<.0001), blood group type B (OR=1.62, P<.005), "Quilty" lesion on previous biopsy (OR=1.70, P<.005), number of HLA mismatches (OR=1.27 per mismatch, P<.005), female sex (OR=1.55, P<.05), and serum creatinine level (OR=0.93 per 10 µmol/L, P<.005). Young age of recipients was a risk factor during long-term (2 years) follow-up (P<.002), and lower cyclosporine level was a risk factor during the first month after transplantation (P<.01). In multivariate logistic regression analysis, ISHT 2 rejection on previous biopsy remained the strongest predictor of rejection ISHT 3A (OR=2.40, P<.0001).
Conclusions Several factors independently increase the risk of rejection classified as ISHT 3A. The strongest predictor of a grade of ISHT 3A was ISHT 2 rejection on the previous biopsy obtained 7 to 10 days earlier. Therefore, ISHT 2 graft rejection is of clinical significance, and short-term follow-up appears to be warranted even late after transplantation.
Key Words: transplantation • rejection • biopsy
This article has been cited by other articles:
 |
|
 |
|
  R. F. Padera Jr. and F. J. Schoen Pathology of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 111 - 178. [Full Text]
|
|
|
|
|
|
F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]
|
|
|
|
 |
|
 D. Babuty, M.C. Machet, P. Neville, M. Aupart, and M.C. Grangeponte Analysis of the distribution of histologic myocardial lesions during acute cardiac rejection. Experimental study in rodents Eur. J. Cardiothorac. Surg., May 1, 2000; 17(5): 592 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Jarcho and E. J. Mark Case 17-1998- A 53-Year-Old Man with Left Ventricular Dysfunction Four Years after a Heart Transplantation N. Engl. J. Med., May 28, 1998; 338(22): 1608 - 1616. [Full Text] [PDF]
|
|