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Peled Y, Lavee J, Ram E, Kassif Y, Peled A, Freimark D, Ofek E, Kogan A. Recurrent acute cellular rejection graded ISHLT 1R early after heart transplantation negatively affects long-term outcomes: The prognostic significance of 1990 ISHLT grades 1B and 2. Transpl Immunol 2019; 55:101204. [PMID: 30904625 DOI: 10.1016/j.trim.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE We investigated the implications of early recurrent 1R rejections for long-term outcomes after heart transplantation (HT) and evaluated the prognostic significance of 1990 ISHLT grading 1B/2 versus 1A. METHODS Data on all patients who underwent HT between 1992 and 2017 were reviewed. Patients with ≥2 endomyocardial biopsies graded 1R in the first 3 months were classified as "recurrent 1R." Those patients were further categorized according to 1A vs. 1B/2. Outcomes (>3 months) were long-term rejections and the combined endpoint of cardiac allograft vasculopathy (CAV) and cardiovascular (CV) mortality. RESULTS Sixty-nine out of 228 patients were classified as recurrent grade 1R. In the recurrent 1R group, 2R rejection rate was significantly higher (2.6 ± 0.6 vs 1.2 ± 0.4, p = 0.03), while survival free of rejections was lower (5-year: 57.1% vs. 72.3%, p = 0.022). Multivariate analysis showed that early recurrent 1R rejection was associated with a 30% increased risk for subsequent major rejection. Among 28 patients classified as 1B/2 of the recurrent group, rejection scores were higher, while survival free of rejections was lower, compared to 37 patients of the recurrent group classified as 1A (5-year: 57.1% vs. 72.7%, p = 0.013). Kaplan-Meier analysis showed that CAV/CV mortality at 10 years of follow-up was significantly higher among the recurrent 1R group (38% vs. 18% p < 0.05). Multivariate analysis showed that early recurrent 1R rejections were associated with a 2.5-fold increased risk for CAV/CV mortality. CONCLUSION Early recurrent grade 1R rejections negatively affect long-term outcomes. The adverse outcomes are experienced mainly by 1R patients subcategorized as1B/2 and not 1A.
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Affiliation(s)
- Yael Peled
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Lavee
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Peled
- Clalit Health Services, Central Region, Israel
| | - Dov Freimark
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Ofek
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Pathology, Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Kogan
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Matsuyama T, Ushigome H, Osaka M, Masuda K, Harada S, Nakamura T, Nobori S, Iida T, Yoshimura N. Short- and Long-Term Outcomes of Live Donor Renal Allografts From Older and Younger Donors. Transplant Proc 2018; 50:3228-3231. [PMID: 30577190 DOI: 10.1016/j.transproceed.2018.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/06/2018] [Accepted: 08/29/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The rising demand for living renal donors has led to the recruitment of older donors. Findings vary, but these grafts appear to survive as long as grafts from standard criteria deceased and expanded criteria deceased donors. We investigated the effects of donor age ≥65 years and the presence or absence of donor antihypertensive therapy on patient condition 1 year after transplantation, and retrospectively examined 1-year (273 patients), 3-year (217 patients), and 5-year (140 patients) patient and graft survival. METHODS We divided 273 donor-recipient pairs into Group Y (donor age <65 years, n = 224) and Group O (donor age ≥65 years, n = 49). Group O was subdivided into donors receiving treatment for hypertension (subgroup O-1, n = 16) and those not receiving treatment for hypertension (subgroup O-2, n = 33). We compared results of 1 hour post-transplant biopsies and looked at a small number of 1 year post-transplant biopsies. RESULTS Although a significantly larger percentage of recipients from younger donors were undergoing preemptive transplantation, and the incidence of arteriosclerosis was significantly higher in the Group O kidneys, there were no significant differences between the 2 groups in terms of patient or graft survival at 1, 3, or 5 years; serum creatinine levels; or number of episodes of acute rejection. The presence or absence of donor antihypertensive treatment had no effect. CONCLUSIONS We found that donor age ≥65, with or without antihypertensive treatment, had no effect on graft or patient survival.
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Affiliation(s)
- T Matsuyama
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - H Ushigome
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - M Osaka
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Masuda
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Harada
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Nakamura
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Nobori
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Iida
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Yoshimura
- Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
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Langstraat M, Musters KJS, Manintveld O, Masetti M, Potena L. Coronary artery disease in heart transplantation: new concepts for an old disease. Transpl Int 2018; 31:787-827. [DOI: 10.1111/tri.13141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | | | | | - Marco Masetti
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
| | - Luciano Potena
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
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Sabatino M, Vitale G, Manfredini V, Masetti M, Borgese L, Maria Raffa G, Loforte A, Martin Suarez S, Falletta C, Marinelli G, Clemenza F, Grigioni F, Potena L. Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: Epidemiology, risk factors, and outcomes. J Heart Lung Transplant 2017; 36:1217-1225. [DOI: 10.1016/j.healun.2017.02.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022] Open
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Vega E, Schroder J, Nicoara A. Postoperative management of heart transplantation patients. Best Pract Res Clin Anaesthesiol 2017; 31:201-213. [PMID: 29110793 DOI: 10.1016/j.bpa.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 01/17/2023]
Abstract
Heart transplant recipients are at risk for a number of post-transplantation complications such as graft dysfunction, rejection, and infection. The rates of many complications are decreasing over time, and prognosis is improving. However, these patients continue to experience significant morbidity and mortality. This review focuses on the optimal management of heart transplant recipients in the postoperative period, based on current knowledge. More information is needed about the best ways to predict, prevent, and treat primary graft dysfunction, right ventricular failure, and cellular and antibody-mediated rejection.
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Affiliation(s)
- Eleanor Vega
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
| | - Jacob Schroder
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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6
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Donor age is a predictor of early low output after heart transplantation. J Cardiol 2016; 67:477-82. [DOI: 10.1016/j.jjcc.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/24/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022]
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Prieto D, Correia P, Batista M, Sola E, Franco F, Costa S, Antunes PE, Antunes MJ. A decade of cardiac transplantation in Coimbra: The value of experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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8
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Uma década de transplantação cardíaca em Coimbra. O valor da experiência. Rev Port Cardiol 2014; 33:671-81. [DOI: 10.1016/j.repc.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/22/2022] Open
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Seki A, Fishbein MC. Predicting the development of cardiac allograft vasculopathy. Cardiovasc Pathol 2014; 23:253-60. [DOI: 10.1016/j.carpath.2014.05.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 12/11/2022] Open
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Pober JS, Jane-wit D, Qin L, Tellides G. Interacting mechanisms in the pathogenesis of cardiac allograft vasculopathy. Arterioscler Thromb Vasc Biol 2014; 34:1609-14. [PMID: 24903097 DOI: 10.1161/atvbaha.114.302818] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cardiac allograft vasculopathy is the major cause of late graft loss in heart transplant recipients. Histological studies of characteristic end-stage lesions reveal arterial changes consisting of a diffuse, confluent, and concentric intimal expansion containing graft-derived cells expressing smooth muscle markers, extracellular matrix, penetrating microvessels, and a host mononuclear cell infiltrate concentrated subjacent to an intact graft-derived luminal endothelial cell lining with little evidence of acute injury. This intimal expansion combined with inadequate compensatory outward remodeling produces severe generalized stenosis extending throughout the epicardial and intramyocardial arterial tree that causes ischemic graft failure. Cardiac allograft vasculopathy lesions affect ≥50% of transplant recipients and are both progressive and refractory to treatment, resulting in ≈5% graft loss per year through the first 10 years after transplant. Lesions typically stop at the suture line, implicating alloimmunity as the primary driver, but pathogenesis may be multifactorial. Here, we will discuss 6 potential contributors to lesion formation (1) conventional risk factors of atherosclerosis; (2) pre- or peritransplant injuries; (3) infection; (4) innate immunity; (5) T-cell-mediated immunity; and (6) B-cell-mediated immunity through production of donor-specific antibody. Finally, we will consider how these various mechanisms may interact with each other.
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Affiliation(s)
- Jordan S Pober
- From the Departments of Immunobiology (J.S.P.), Internal Medicine (D.J.-w.), and Surgery (L.Q. and G.T.), Yale University School of Medicine, New Haven, CT.
| | - Dan Jane-wit
- From the Departments of Immunobiology (J.S.P.), Internal Medicine (D.J.-w.), and Surgery (L.Q. and G.T.), Yale University School of Medicine, New Haven, CT
| | - Lingfeng Qin
- From the Departments of Immunobiology (J.S.P.), Internal Medicine (D.J.-w.), and Surgery (L.Q. and G.T.), Yale University School of Medicine, New Haven, CT
| | - George Tellides
- From the Departments of Immunobiology (J.S.P.), Internal Medicine (D.J.-w.), and Surgery (L.Q. and G.T.), Yale University School of Medicine, New Haven, CT
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