Patterns of Acute Cellular Rejection the First Year after Heart Transplantation: A Single Center Retrospective Study at Skåne University Hospital in Lund 1988-2010

Abstract

Purpose Our purpose was to investigate patterns of acute cellular rejection (ACR) the first year after heart transplantation (HT). Methods and Materials Records from all 215 HT patients followed in Lund 1988-2010, including 219 HTs (five re-HTs) and 2990 endomyocardial biopsies (EMBs), were studied. Routine EMBs taken 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40 and 52 weeks after HT, and extra EMBs taken upon suspicion of ACR, were graded according to the 1990-ISHLT-working-formulation. End of follow up was June 30, 2012. Results The frequency, and severity, of ACRs, were low, with 7% of routine and 14% of extra EMBs showing 1 st -year ACR≥grade 2. There were more (p st -year ACRs≥grade 2 among EMBs; in HTs performed 1988-1999 (9.56%, “Early Era”) than 2000-2010 (5.54%, “Late Era”) , performed 16-52 (8.82%) than 1-12 (6.33%) weeks after HT, in sex-mismatched (10.37%) than sex-matched HTs (6.32%) , and in HTs with pediatric (11.31%) than adult (7.11%) donors. Long-term survival was better (p st -year ACRs≥grade 2 compared to one or more 1 st -year ACRs≥grade 2; with 94% vs. 83% and 87% vs. 70% alive 5- and 10 years after HT, respectively. The same applied for patients with no 1 st -year ACRs≥grade 3A/3B compared to one or more 1 st -year ACRs≥grade 3A/3B; with 92% vs. 82% and 82% vs. 69% alive 5- and 10 years after HT, respectively. Conclusions The low frequency of 1 st -year ACRs≥grade 2 reflects an effective immunosuppression, resulting in high patient survival. The poorer long-term survival in patients with 1 st -year ACRs≥grade 2 and ≥grade 3A/3B stresses the importance of careful follow-up, with continuous adjustments of immunosuppression. The patterns of 1 st -year ACRs≥grade 2 in relation to year of HT, week after HT, sex-matching between recipient and donor, and age of donor, may provide guidance in treatment of ACR the first year after HT, and in selection of recipients and donors for HT.