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Significance of pericardial effusion after heart transplantation
G R Ciliberto1, M C Anjos, E Gronda
1Department of Cardiology, Ospedale Cá Granda, Milan, Italy.
Insights
Pericardial effusion after heart transplantation is linked to more frequent and severe acute rejection episodes. Early detection and monitoring of effusion are crucial for better patient outcomes in transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Pericardial effusion is a potential complication following heart transplantation.
- Understanding its clinical significance and relationship with acute rejection is vital for patient management.
Purpose of the Study:
- To evaluate the clinical significance of pericardial effusion post-heart transplant.
- To assess the correlation between pericardial effusion and acute rejection episodes.
Main Methods:
- Serial echocardiography and endomyocardial biopsies in 150 heart transplant recipients during the first year.
- Classification of patients based on pericardial effusion presence and course.
- Analysis of rejection episodes, histologic grading, and correlation with effusion evolution.
Main Results:
- Pericardial effusion was associated with severe postoperative bleeding.
- Patients with persistent or increasing effusion had a different evolution concerning acute rejection.
- Pericardial effusion correlated significantly with the incidence, severity, and duration of acute rejection episodes.
Conclusions:
- Pericardial effusion in heart transplant recipients is associated with a higher incidence and more severe histologic grading of acute rejection.
- The presence of pericardial effusion necessitates stricter monitoring for acute rejection.
Abstract:
The aim of this study was to evaluate the clinical significance of pericardial effusion after heart transplantation and to assess its correlation with acute rejection. One hundred fifty transplanted patients were followed up for the first year: serial echocardiographic studies were performed on the same day as were the endomyocardial biopsies; hemodynamic studies and coronary angiographies were performed 1 year after transplant. Ten days after surgery, pericardial effusion was absent in 77 patients, small in 52, moderate in 14, and large in 7, and was significantly related to severe postoperative bleeding (p < 0.001). Patients were classified according to the presence and the course of pericardial effusion in group A (absence or disappearance of previous pericardial effusion within 1 month, 107 patients) and in group B (onset, persistence, or increase in pericardial effusion, 43 patients). One hundred nineteen patients experienced > or = 1 acute rejection episode. The evolution of pericardial effusion was different (p < 0.0001) according to the number of acute rejection episodes and biopsy specimens showing acute rejection, histologic grading and time of the first episode, and histologic grading of the most severe acute rejection episode. Furthermore, there was a significant correlation with the cumulative duration of acute rejection episodes (p < 0.005) and the presence of previous cardiac surgical history (p < 0.007), but no correlation with cardiac transplant vasculopathy or with a positive weight mismatch. This study suggests that pericardial effusion in transplant recipients is associated with a higher incidence and more severe histologic grading of acute rejection episodes; its presence indicates the need for stricter monitoring of acute rejection.