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Early screening for antibody-mediated rejection in heart transplant recipients.
- Source :
-
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2007 Dec; Vol. 26 (12), pp. 1264-9. Date of Electronic Publication: 2007 Nov 26. - Publication Year :
- 2007
-
Abstract
- Background: The International Society for Heart and Lung Transplantation (ISHLT) recently established a diagnostic scheme for antibody-mediated rejection (AMR). Currently, however, confirmatory immunohistochemistry studies are recommended only if AMR is clinically or histologically suspected. In this study, we examine whether a pattern of repetitive AMR occurred early enough after transplantation to warrant prospective immunohistochemistry screening in all recently transplanted recipients.<br />Methods: We queried our pathology database of adult and pediatric endomyocardial biopsies (EMBs) from 1985 to 2005. All EMB specimens were prospectively studied by immunofluorescence in the early post-operative period. AMR was defined as the presence of complement and immunoglobulin deposits on frozen section. Only patients classified as antibody-mediated rejectors (>or=3 episodes of AMR) were included. Cumulative incidence and time from transplant to first and third AMR episodes were obtained.<br />Results: Three hundred seventy-five of 870 heart transplant recipients had >or=3 episodes of AMR. Mean age of recipients was 45.6 years and 78% were male. A total of 19,569 EMBs comprised the study data. By 100 days post-transplant, 85% of patients had their first and 54% their third AMR. In addition, patients showed a clear trend of early clustering of AMR-positive biopsies. Results were similar regardless of whether or not muromonab-CD3 (Orthoclone OKT3) induction was used.<br />Conclusions: We advocate early immunohistochemical surveillance testing for AMR to supplement the diagnostic algorithm established by the ISHLT, because a pattern of AMR becomes manifest soon after transplantation. This change will allow earlier detection of asymptomatic AMR and may prompt changes in immunosuppression strategies to avoid adverse outcomes.
- Subjects :
- Adult
Algorithms
Biopsy
Complement System Proteins immunology
Female
Heart Transplantation adverse effects
Humans
Immunoglobulins immunology
Immunosuppression Therapy methods
Immunosuppressive Agents therapeutic use
Male
Middle Aged
Muromonab-CD3 therapeutic use
Myocardium immunology
Myocardium pathology
Retrospective Studies
Antibodies immunology
Graft Rejection diagnosis
Graft Rejection immunology
Heart Transplantation immunology
Mass Screening methods
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3117
- Volume :
- 26
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 18096477
- Full Text :
- https://doi.org/10.1016/j.healun.2007.09.011