Abstract
Background Graft dysfunction (GD) after heart transplantation (HTx) is a major cause of morbidity and mortality. The impact of different pathophysiologic mechanisms on outcome is unknown. In this large, single-center study we aimed to assess the incidence of GD and compare the outcomes with different histopathologic mechanisms of rejection. Methods We analyzed a data set of 1,099 consecutive patients after their HTx at Columbia University Medical Center between January 1994 and March 2008, and identified all patients hospitalized with new-onset GD. Based on the histopathologic data, patients were divided into GD-unexplained (Group-GD-U), GD-antibody-mediated rejection (Group-GD-AMR), GD-cardiac allograft vasculopathy (Group-GD-CAV) and GD-acute cellular rejection (Group-GD-ACR) groups. We compared the in-hospital and 3-, 6- and 12-month mortality across these groups using the chi-square test. We also compared the 3-, 6- and 12-month survival curves across groups using the log-rank test. Results Of 126 patients (12%) identified with GD, complete histology data were available for 100 patients. There were 21, 20, 27 and 32 patients identified in Group-GD-U, Group-GD-AMR, Group-GD-CAV and Group-GD-ACR, respectively. The in-hospital mortality rates were 52%, 20%, 15% and 6%, respectively. The in-hospital mortality rate was significantly higher in Group-GD-U compared with all other groups (p = 0.0006). The 3-, 6- and 12-month survival rate was also significantly lower in Group-GD-U compared with all other groups. Conclusion A significant proportion of patients presenting with new-onset GD have unexplained histopathology. Unexplained GD is associated with a significantly higher mortality rate. New diagnostic tools are necessary to better understand and detect/predict this malignant phenotype. Crown
| Original language | English (US) |
|---|---|
| Pages (from-to) | 194-203 |
| Number of pages | 10 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 30 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2011 |
| Externally published | Yes |
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Keywords
- acute cellular rejection
- antibody-mediated rejection
- cardiac allograft vasculopathy
- graft dysfunction
- heart transplant
- unexplained graft dysfunction
ASJC Scopus subject areas
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine
- Transplantation
Cite this
New-onset graft dysfunction after heart transplantationincidence and mechanism-related outcomes. / Shahzad, Khurram; Aziz, Quratul Ain; Leva, Jean Paul; Cadeiras, Martin; Ho, Eric K.; Vlad, George; Vasilescu, E. Rodica; Latif, Farhana; Sinha, Anshu; Burke, Elizabeth; Addonizio, Linda J.; Restaino, Susan W.; Marboe, Charles C.; Suciu-Foca, Nicole; Naka, Yoshifumi; Mancini, Donna; Deng, Mario C.
In: Journal of Heart and Lung Transplantation, Vol. 30, No. 2, 01.02.2011, p. 194-203.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - New-onset graft dysfunction after heart transplantationincidence and mechanism-related outcomes
AU - Shahzad, Khurram
AU - Aziz, Quratul Ain
AU - Leva, Jean Paul
AU - Cadeiras, Martin
AU - Ho, Eric K.
AU - Vlad, George
AU - Vasilescu, E. Rodica
AU - Latif, Farhana
AU - Sinha, Anshu
AU - Burke, Elizabeth
AU - Addonizio, Linda J.
AU - Restaino, Susan W.
AU - Marboe, Charles C.
AU - Suciu-Foca, Nicole
AU - Naka, Yoshifumi
AU - Mancini, Donna
AU - Deng, Mario C.
PY - 2011/2/1
Y1 - 2011/2/1
N2 - Background Graft dysfunction (GD) after heart transplantation (HTx) is a major cause of morbidity and mortality. The impact of different pathophysiologic mechanisms on outcome is unknown. In this large, single-center study we aimed to assess the incidence of GD and compare the outcomes with different histopathologic mechanisms of rejection. Methods We analyzed a data set of 1,099 consecutive patients after their HTx at Columbia University Medical Center between January 1994 and March 2008, and identified all patients hospitalized with new-onset GD. Based on the histopathologic data, patients were divided into GD-unexplained (Group-GD-U), GD-antibody-mediated rejection (Group-GD-AMR), GD-cardiac allograft vasculopathy (Group-GD-CAV) and GD-acute cellular rejection (Group-GD-ACR) groups. We compared the in-hospital and 3-, 6- and 12-month mortality across these groups using the chi-square test. We also compared the 3-, 6- and 12-month survival curves across groups using the log-rank test. Results Of 126 patients (12%) identified with GD, complete histology data were available for 100 patients. There were 21, 20, 27 and 32 patients identified in Group-GD-U, Group-GD-AMR, Group-GD-CAV and Group-GD-ACR, respectively. The in-hospital mortality rates were 52%, 20%, 15% and 6%, respectively. The in-hospital mortality rate was significantly higher in Group-GD-U compared with all other groups (p = 0.0006). The 3-, 6- and 12-month survival rate was also significantly lower in Group-GD-U compared with all other groups. Conclusion A significant proportion of patients presenting with new-onset GD have unexplained histopathology. Unexplained GD is associated with a significantly higher mortality rate. New diagnostic tools are necessary to better understand and detect/predict this malignant phenotype. Crown
AB - Background Graft dysfunction (GD) after heart transplantation (HTx) is a major cause of morbidity and mortality. The impact of different pathophysiologic mechanisms on outcome is unknown. In this large, single-center study we aimed to assess the incidence of GD and compare the outcomes with different histopathologic mechanisms of rejection. Methods We analyzed a data set of 1,099 consecutive patients after their HTx at Columbia University Medical Center between January 1994 and March 2008, and identified all patients hospitalized with new-onset GD. Based on the histopathologic data, patients were divided into GD-unexplained (Group-GD-U), GD-antibody-mediated rejection (Group-GD-AMR), GD-cardiac allograft vasculopathy (Group-GD-CAV) and GD-acute cellular rejection (Group-GD-ACR) groups. We compared the in-hospital and 3-, 6- and 12-month mortality across these groups using the chi-square test. We also compared the 3-, 6- and 12-month survival curves across groups using the log-rank test. Results Of 126 patients (12%) identified with GD, complete histology data were available for 100 patients. There were 21, 20, 27 and 32 patients identified in Group-GD-U, Group-GD-AMR, Group-GD-CAV and Group-GD-ACR, respectively. The in-hospital mortality rates were 52%, 20%, 15% and 6%, respectively. The in-hospital mortality rate was significantly higher in Group-GD-U compared with all other groups (p = 0.0006). The 3-, 6- and 12-month survival rate was also significantly lower in Group-GD-U compared with all other groups. Conclusion A significant proportion of patients presenting with new-onset GD have unexplained histopathology. Unexplained GD is associated with a significantly higher mortality rate. New diagnostic tools are necessary to better understand and detect/predict this malignant phenotype. Crown
KW - acute cellular rejection
KW - antibody-mediated rejection
KW - cardiac allograft vasculopathy
KW - graft dysfunction
KW - heart transplant
KW - unexplained graft dysfunction
UR - http://www.scopus.com/inward/record.url?scp=78650932934&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78650932934&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2010.08.026
DO - 10.1016/j.healun.2010.08.026
M3 - Article
C2 - 20952209
AN - SCOPUS:78650932934
VL - 30
SP - 194
EP - 203
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 2
ER -