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CONSEQUENCES OF FIRST-YEAR REJECTION AFTER HEART TRANSPLANTATION: IS THE WORSE YET TO COME?
E992 JACC March 27, 2012 Volume 59, Issue 13
Heart Failure CONSEQUENCES OF FIRST-YEAR REJECTION AFTER HEART TRANSPLANTATION: IS THE WORSE YET TO COME? ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 11:00 a.m.-Noon
Session Title: Cardiac Transplantation: Support, Sensitization and Rejection Abstract Category: 13. Heart Failure: Therapy Presentation Number: 1217-247 Authors: Rigved Tadwalkar, Jignesh Patel, Michelle Kittleson, Lawrence Czer, Jon Kobashigawa, Cedars-Sinai Heart institute, Los Angeles, CA, USA Purpose: The ISHLT registry has reported that first-year rejection is associated with reduced survival after heart transplantation. Historically, rejection has been categorized as cellular (Cell R) or non-cellular (Non Cell R) (prior to a standardized definition for antibody-mediated rejection). In the first year after transplant, patients can experience either type of rejection or both (Both R). We chose to assess whether a specific type of firstyear rejection was more responsible for reduced survival and other outcomes. Methods: Between 1994 and 2010, we assessed 1,384 heart transplant patients for first year rejection after heart transplantation. Specifically, patients with first-year rejection were categorized into groups of CellR (n=129), NonCellR (n=90) or BothR (n=21). Patients who experienced no rejection served as the control group (NoR, n=1,144). These groups were then followed for 5-year survival, cardiac allograft vasculopathy (CAV), and non-fatal major adverse cardiac events (NF-MACE: MI, CHF, angioplasty, pacemaker/ ICD, stroke). Results: The CellR, NonCellR, and BothR groups all had significantly lower 5-year actuarial survival compared to the NoR group(69%, 69%, 62% vs 77%, p=0.05). In addition, compared to the NoR group, there was significantly lower freedom from CAV (69%, 73%, 67% vs 82%, p<0.001) and NFMACE (81%, 87%, 71% vs 89%, p=0.003). Conclusion: Heart transplant patients who experience first year rejection compared to those patient without rejection, regardless of cellular or non-cellular variety, not only have reduced survival but more development of CAV and NF-MACE at 5-years. Patients with first-year rejection should be considered for closer monitoring and perhaps augmented immunosuppression in attempts to alter their subsequent poor outcomes.
Heart Failure CONSEQUENCES OF FIRST-YEAR REJECTION AFTER HEART TRANSPLANTATION: IS THE WORSE YET TO COME? ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 11:00 a.m.-Noon
Session Title: Cardiac Transplantation: Support, Sensitization and Rejection Abstract Category: 13. Heart Failure: Therapy Presentation Number: 1217-247 Authors: Rigved Tadwalkar, Jignesh Patel, Michelle Kittleson, Lawrence Czer, Jon Kobashigawa, Cedars-Sinai Heart institute, Los Angeles, CA, USA Purpose: The ISHLT registry has reported that first-year rejection is associated with reduced survival after heart transplantation. Historically, rejection has been categorized as cellular (Cell R) or non-cellular (Non Cell R) (prior to a standardized definition for antibody-mediated rejection). In the first year after transplant, patients can experience either type of rejection or both (Both R). We chose to assess whether a specific type of firstyear rejection was more responsible for reduced survival and other outcomes. Methods: Between 1994 and 2010, we assessed 1,384 heart transplant patients for first year rejection after heart transplantation. Specifically, patients with first-year rejection were categorized into groups of CellR (n=129), NonCellR (n=90) or BothR (n=21). Patients who experienced no rejection served as the control group (NoR, n=1,144). These groups were then followed for 5-year survival, cardiac allograft vasculopathy (CAV), and non-fatal major adverse cardiac events (NF-MACE: MI, CHF, angioplasty, pacemaker/ ICD, stroke). Results: The CellR, NonCellR, and BothR groups all had significantly lower 5-year actuarial survival compared to the NoR group(69%, 69%, 62% vs 77%, p=0.05). In addition, compared to the NoR group, there was significantly lower freedom from CAV (69%, 73%, 67% vs 82%, p<0.001) and NFMACE (81%, 87%, 71% vs 89%, p=0.003). Conclusion: Heart transplant patients who experience first year rejection compared to those patient without rejection, regardless of cellular or non-cellular variety, not only have reduced survival but more development of CAV and NF-MACE at 5-years. Patients with first-year rejection should be considered for closer monitoring and perhaps augmented immunosuppression in attempts to alter their subsequent poor outcomes.