New-onset graft dysfunction after heart transplantation—incidence and mechanism-related outcomes

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• 作者：Khurram Shahzad MD^a ; Quratul Ain Aziz MD^a ; Jean-Paul Leva BS^a ; Martin Cadeiras MD^a ; Eric K. Ho MD^b ; George Vlad MD^b ; E. Rodica Vasilescu MD^b ; Farhana Latif MD^a ; Anshu Sinha PhD^c ; Elizabeth Burke^a ; Linda J. Addonizio MD^d ; Susan W. Restaino MD^a ; Charles C. Marboe MD^b ; Nicole Suciu-Foca MD^b ; Yoshifumi Naka MD ; PhD^e ; Donna Mancini MD^a ; Mario C. Deng MD^a ; ^{md785@columbia.edu}
• 关键词：heart transplant ; graft dysfunction ; acute cellular rejection ; antibody-mediated rejection ; cardiac allograft vasculopathy
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2011
• 出版时间：February 2011
• 年：2011
• 卷：30
• 期：2
• 页码：194-203
• 全文大小：1576 K

文摘

Background

Graft dysfunction (GD) after heart transplantation (HTx) is a major cause of morbidity and mortality. The impact of different pathophysiologic mechanisms on outcome is unknown. In this large, single-center study we aimed to assess the incidence of GD and compare the outcomes with different histopathologic mechanisms of rejection.

Methods

We analyzed a data set of 1,099 consecutive patients after their HTx at Columbia University Medical Center between January 1994 and March 2008, and identified all patients hospitalized with new-onset GD. Based on the histopathologic data, patients were divided into GD-unexplained (Group-GD-U), GD-antibody-mediated rejection (Group-GD-AMR), GD-cardiac allograft vasculopathy (Group-GD-CAV) and GD-acute cellular rejection (Group-GD-ACR) groups. We compared the in-hospital and 3-, 6- and 12-month mortality across these groups using the chi-square test. We also compared the 3-, 6- and 12-month survival curves across groups using the log-rank test.

Results

Of 126 patients (12 % ) identified with GD, complete histology data were available for 100 patients. There were 21, 20, 27 and 32 patients identified in Group-GD-U, Group-GD-AMR, Group-GD-CAV and Group-GD-ACR, respectively. The in-hospital mortality rates were 52 % , 20 % , 15 % and 6 % , respectively. The in-hospital mortality rate was significantly higher in Group-GD-U compared with all other groups (p = 0.0006). The 3-, 6- and 12-month survival rate was also significantly lower in Group-GD-U compared with all other groups.

Conclusion

A significant proportion of patients presenting with new-onset GD have unexplained histopathology. Unexplained GD is associated with a significantly higher mortality rate. New diagnostic tools are necessary to better understand and detect/predict this malignant phenotype.