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Does acute cellular rejection correlate with cardiac allograft vasculopathy?
Mohamad H Yamani1, Mohammed Yousufuddin, Randall C Starling
1Cardiovascular Medicine, Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. Yamanim@ccf.org
Summary
Myocardial fibrosis masks the link between acute cellular rejection and cardiac allograft vasculopathy (CAV). Fibrosis indicates non-immune graft injury, independently increasing CAV risk after heart transplantation.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pathology
Background:
- Conflicting evidence exists regarding the association between acute cellular rejection and cardiac allograft vasculopathy (CAV).
- A potential confounding variable may obscure this relationship in heart transplant recipients.
Purpose of the Study:
- To investigate the association between acute cellular rejection and the extent of CAV.
- To identify confounding factors influencing this association.
Main Methods:
- 140 heart transplant patients underwent serial intravascular ultrasound to assess CAV (change in maximal intimal thickness).
- Biopsies were analyzed for acute cellular rejection using standard and novel scoring systems, and for myocardial fibrosis.
- Patients were stratified based on the presence or absence of biopsy-proven myocardial fibrosis.
Main Results:
- No significant association between CAV and acute cellular rejection was found in the overall cohort (n=140).
- A significant correlation emerged in patients without myocardial fibrosis (n=57), particularly with the novel rejection scoring method (r=0.51, p<0.0001).
- A novel biopsy-scoring system showed a stronger association with CAV extent than the standard method.
Conclusions:
- Myocardial fibrosis masks the association between acute cellular rejection and de novo cardiac allograft vasculopathy.
- Myocardial fibrosis serves as a marker for non-immune-mediated graft injury, independently linked to increased CAV incidence.