Heart transplant rejection with hemodynamic compromise: A multiinstitutional study of the role of endomyocardial cellular infiltrate

摘要: Background The natural history of patients experiencing hemodynamic compromise with rejection has been incompletely characterized. This multiinstitutional study examined the outcome such episodes, particularly regard to extent cellular infiltrate on index endomyocardial biopsy. Methods From January 1, 1990, through June 30, 1994, 3367 in Cardiac Transplant Research Database experienced 4137 episodes rejection. Severe occurred approximately 5% and this proportion remained relatively constant over time. Results Recipient risk factors for severe included black race, female recipient sex, diabetes. 3-month actuarial survival rate was 60% after versus 95% no or mild compromise. Low initial biopsy score conferred a higher early survival, but lower at 2 years Among who survive an episode compromise, 46% among those had low 84% high score. Conclusions Rejection although rare, represents major complication heart transplantation poor long-term outcome. Survivors hemodynamically compromising associated scores International Society Heart Lung Transplantation grading system have significantly worse than survivors scores. These findings suggest that immunologic mechanisms other lymphocytic infiltration cardiac allograft are important distinct causes dysfunction.