New-onset graft dysfunction after heart transplantationincidence and mechanism-related outcomes

Khurram Shahzad, Quratul Ain Aziz, Jean Paul Leva, Martin Cadeiras, Eric K. Ho, George Vlad, E. Rodica Vasilescu, Farhana Latif, Anshu Sinha, Elizabeth Burke, Linda J. Addonizio, Susan W. Restaino, Charles C. Marboe, Nicole Suciu-Foca, Yoshifumi Naka, Donna Mancini, Mario C. Deng

Research output: Contribution to journalArticle

17 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)194-203
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number2
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

Fingerprint

Transplants
Mortality
Hospital Mortality
Allografts
Antibodies
Graft Rejection
Heart Transplantation
Chi-Square Distribution
Crowns
Histology
Survival Rate
Morbidity
Phenotype
Survival
Incidence

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 journalArticle

Shahzad, K, Aziz, QA, Leva, JP, Cadeiras, M, Ho, EK, Vlad, G, Vasilescu, ER, Latif, F, Sinha, A, Burke, E, Addonizio, LJ, Restaino, SW, Marboe, CC, Suciu-Foca, N, Naka, Y, Mancini, D & Deng, MC 2011, 'New-onset graft dysfunction after heart transplantationincidence and mechanism-related outcomes', Journal of Heart and Lung Transplantation, vol. 30, no. 2, pp. 194-203. https://doi.org/10.1016/j.healun.2010.08.026
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. / New-onset graft dysfunction after heart transplantationincidence and mechanism-related outcomes. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 2. pp. 194-203.
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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",
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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

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