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Antibody-mediated rejection induced cardiogenic shock: Too late for conventional therapy

Guillaume Coutance1, Lucas Van Aelst1,2, Guillaume Hékimian3

  • 1Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.

Clinical Transplantation
|April 8, 2018
PubMed

Insights

Prognosis for heart transplant recipients experiencing antibody-mediated rejection (AMR) with cardiogenic shock (CS) is poor. Aggressive treatment showed high mortality, with most cases linked to de novo donor-specific antibodies (DSA).

Area of Science:

  • Cardiology
  • Transplantation Immunology

Background:

  • Data on the prognosis of heart allograft antibody-mediated rejection (AMR) complicated by cardiogenic shock (CS) are limited.
  • Antibody-mediated rejection (AMR) is a significant concern following heart transplantation.

Purpose of the Study:

  • To analyze the characteristics, treatment, and outcomes of patients with biopsy-proven AMR and CS.
  • To investigate the prognosis and recurrence of AMR in heart transplant recipients with CS.

Main Methods:

  • Retrospective, single-center observational study.
  • Inclusion criteria: biopsy-proven AMR and CS.
  • Follow-up for graft function, AMR recurrence, and cardiac allograft vasculopathy (CAV) in survivors.

Main Results:

  • Seventeen patients (70% male, median age 56 years) were included; AMR occurred at a median of 21 months post-transplant.
  • Most cases involved de novo class II donor-specific antibodies (DSA); only 2 had prior AMR history.
  • In-hospital and 1-year mortality rates were high (76% and 82%, respectively), despite aggressive immunosuppression.

Conclusions:

  • Cardiogenic shock due to AMR, particularly with de novo class II DSA, carries a poor prognosis.
  • Aggressive conventional immunosuppressive therapies demonstrated limited efficacy in improving survival for these patients.
Abstract

Keywords:
alloantibodyantibody-mediated (ABMR)extracorporeal membrane oxygenation (ECMO)heart (allograft) dysfunctionrejection

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