Cardiac rejectionHumoral rejection in cardiac transplantation: risk factors, hemodynamic consequences and relationship to transplant coronary artery disease
Section snippets
Patients and tissues studied
The pathologic diagnosis of humoral rejection (HR) was made in a total of 116 endomyocardial biopsy (EMB) specimens from 56 patients between July 1997 and January 2001. During this period, approximately 600 cardiac transplant patients were being followed with surveillance biopsies and coronary angiography at our institution. Of these patients with HR, 44 (77 biopsies) were diagnosed with HR without concurrent acute cellular rejection (ISHLT Grade 0). Individual EMB specimens were obtained from
Patient demographics
A total of 44 patients (4 to 74 years old) showed evidence of HR without concurrent acute cellular rejection. In addition to the findings on H&E-stained histologic sections, the diagnosis was made by immunofluorescence (n = 7) and/or immunohistochemical criteria (n = 37), as indicated. Up to January 2001, a total of 1,090 patients have received orthotopic heart transplantation (OHT) at our institution. Although only 78 (26%) of the 298 patients without HR transplanted since July 1997 were
Discussion
The results of our study confirm the original observations of Hammond and associates9 and further delineate the features and sequelae of HR in cardiac transplant recipients. We have document an increased incidence of HR in women, patients with a history of re-transplantation and those with a positive peri-operative T-cell flow cytometry crossmatch. In addition, patients who develop HR are at an increased risk for early development of TCAD and have a relatively high rejection-associated
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