Clinical Relevance of Vasculitis in Heart Transplant

Abstract

Aim of the study to assess the clinical relevance of vasculitis, in terms of survival and cardiac allograft vasculopathy development in the mild forms of rejection in HTx adult patients METHODS: We review 2639 monitoring EMBs from 172 adult heart transplanted pts at our center from January 2008 to September 2016, median follow up of 4,59 (range 0,13-8,78 years), with a mean of 15 EMB per pts. For each EMB we evaluated vasculitis and types of rejection classified according to 1990 and 2005 ISHLT classification for ACR and 2013 ISHLT classification for AMR. Clinical data were collected during follow up. For statistical analysis we applied the Multi-State Markov (MSM) model to describe the rejection profile of the subjects during the follow-up. Four hundred and twelve EMBs were positive for vasculitis, (412 / 2639; 15,6%), in 134 pts (134/172; 78,5%). In acute cellular rejection vasculitis was present in 329/964 (34,1%) in 1R, in 69/132 (52,3%) in 2R and 14/20 (70%) in 3R. In antibody mediated rejection vasculitis was present in 52/144 (36%) of EMBs. Transition probabilities showed that presence of vasculitis associated to ACR carries a risk of persistence of rejections of 78% (95% CI, 74%-82%), whereas vasculitis associated to pAMR carries a risk of persistence of rejection of 50% (95% CI, 30%-70%). The transitions rate risk of develop CAV was 11.01 (95% CI, 8.61-14.84) fold higher for vasculitis with pAMR+ACR compared to any other rejections without vasculitis. The transition rate risk for death was 21.18 (95% CI, 8.61-109.06) fold higher risk for vasculitis + pAMR and 2.83 (95% CI, 1.08-7.94) fold higher risk vasculitis with pAMR+ACR compared to any other rejections without vasculitis. Vasculitis was present in any grades and types of rejection and is associated with persistence of rejection, CAV development and death. The worse histopathological features is represented by the association of pAMR+ACR and vasculitis.