Anergic response to delayed hypersensitivity skin testing. A predictor of early mortality in heart transplant...

We set out to determine if there is a significant difference in the morbidity and mortality between the anergic and reactive groups.

A retrospective study of the heart transplant population was performed.

We studied the results of delayed hypersensitivity skin tests (DHSTs) in all cardiac transplant recipients at the Cleveland Clinic between May 1985 and November 1991 to determine whether DHST results were of prognostic significance.

Preoperative skin testing was reactive to two or more antigens in 90 of the 127 patients whose DHSTs were interpretable, and the remainder were anergic. Anergic response was associated with increased bilirubin and decreased albumin levels, but gender, race, primary underlying heart disease, age at transplantation, creatinine level, hematocrit, glucose level, and ejection fraction were not related to anergy. Anergic patients had significantly higher mortality at 30, 60, and 90 days after transplantation, but long-term mortality was not significantly different from patients reactive on DHSTs (p = 0.267).

We conclude that the DHSTs provide useful information regarding risk of early mortality after heart transplantation.