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Published on: December 4, 2010

The cumulative effect of acute rejection on development of cardiac allograft vasculopathy

Serban C Stoica1, Fay Cafferty, Mahesh Pauriah

  • 1Department of Transplantation, Papworth Hospital, Cambridge, UK. serbanstoica@hotmail.com

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|March 28, 2006
PubMed

Insights

Moderate to severe acute rejection episodes in heart transplant recipients significantly increase the risk of cardiac allograft vasculopathy (CAV) onset. Mild rejection does not appear to impact CAV development, highlighting the importance of managing rejection severity.

Area of Science:

  • Cardiology
  • Transplantation Immunology
  • Medical Statistics

Background:

  • Acute rejection is a significant complication following heart transplantation.
  • It increases organ inflammation and predisposes recipients to cardiac allograft vasculopathy (CAV).
  • Differentiating the impact of mild versus severe rejection on CAV is crucial.

Purpose of the Study:

  • To quantify the association between acute rejection episodes and the development of CAV.
  • To distinguish the effects of mild versus moderate/severe acute rejection on CAV onset.

Main Methods:

  • Analysis of 1,435 angiograms from 489 heart transplant recipients surviving 1 year (1988-2003).
  • Classification of CAV into no CAV (0% stenosis), mild/moderate (<70%), and severe (>70%) stenosis.
  • Categorization of acute rejection into mild (Grades 1A, 1B, 2 untreated) and moderate/severe (Grade 2 treated, Grades 3A, 3B, 4).
  • Utilized multi-state Markov models to identify CAV risk factors.

Main Results:

  • Moderate/severe acute rejection episodes significantly increase CAV onset risk (RR 1.10 per episode).
  • Donor age, male recipient, and pre-transplant ischemic disease were also significant risk factors for CAV.
  • Estimated annual CAV onset rates were 11.3% (no moderate/severe rejection), 13.6% (two episodes), and 18.0% (five episodes).
  • Mild rejection, HLA/CMV matching, donor gender, recipient age, smoking, and CMV infections were not significant risk factors.

Conclusions:

  • Acute moderate/severe cellular rejection has a cumulative detrimental effect on the onset of cardiac allograft vasculopathy.
  • Mild, untreated acute rejection episodes are not associated with an increased risk of developing CAV.
Abstract

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