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Cardiac allograft rejection late after transplantation is a risk factor for graft coronary artery disease

H P Brunner-La Rocca1, J Schneider, A Künzli

  • 1Division of Cardiology, University Hospital Zurich, Switzerland.

Transplantation
|March 21, 1998
PubMed

Insights

Cellular rejection episodes requiring increased immunosuppression, both early and late after heart transplantation, significantly increase the risk of developing graft coronary artery disease (CAD). Aggressively treating rejection is crucial for long-term graft survival.

Area of Science:

  • Cardiology
  • Immunology
  • Transplantation Medicine

Background:

  • Graft coronary artery disease (CAD) is a significant concern in long-term heart transplant recipients.
  • The role of cellular rejection, especially late after transplantation, in graft CAD development is not fully understood.

Purpose of the Study:

  • To investigate the association between cellular rejection and the development of angiographically detectable graft CAD in heart transplant recipients.
  • To identify independent predictors of graft CAD in this population.

Main Methods:

  • Analysis of 492 coronary angiographies and 5201 endomyocardial biopsies from 156 heart transplant patients.
  • Multivariate logistic regression analysis incorporating rejection episodes, cytomegalovirus infection, donor age, and smoking status.

Main Results:

  • Patients with graft CAD experienced significantly more rejection episodes than those without, both early and late post-transplant.
  • Number of rejections (early and late), prior cytomegalovirus infection, older donor age, and smoker status were independent predictors of graft CAD.
  • Late rejection episodes strongly predicted graft CAD, even in patients without detectable disease at one year.

Conclusions:

  • Rejection episodes requiring augmented immunosuppression, occurring both early and late post-transplant, are independent risk factors for graft CAD.
  • Proactive identification and management of moderate to severe rejection are recommended, even in the late stages after heart transplantation.
Abstract

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