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Recurrent acute cellular rejection graded ISHLT 1R early after heart transplantation negatively affects long-term outcomes: The prognostic significance of 1990 ISHLT grades 1B and 2.
Transplant Immunology ( IF 1.5 ) Pub Date : 2019-03-21 , DOI: 10.1016/j.trim.2019.03.003
Yael Peled 1 , Jacob Lavee 1 , Eilon Ram 1 , Yigal Kassif 1 , Amir Peled 2 , Dov Freimark 1 , Efrat Ofek 3 , Alexander Kogan 1
Affiliation  

Purpose

We investigated the implications of early recurrent 1R rejections for long-term outcomes after heart transplantation (HT) and evaluated the prognostic significance of 1990 ISHLT grading 1B/2 versus 1A.

Methods

Data on all patients who underwent HT between 1992 and 2017 were reviewed. Patients with ≥2 endomyocardial biopsies graded 1R in the first 3 months were classified as “recurrent 1R.” Those patients were further categorized according to 1A vs. 1B/2. Outcomes (>3 months) were long-term rejections and the combined endpoint of cardiac allograft vasculopathy (CAV) and cardiovascular (CV) mortality.

Results

Sixty-nine out of 228 patients were classified as recurrent grade 1R. In the recurrent 1R group, 2R rejection rate was significantly higher (2.6 ± 0.6 vs 1.2 ± 0.4, p = 0.03), while survival free of rejections was lower (5-year: 57.1% vs. 72.3%, p = 0.022). Multivariate analysis showed that early recurrent 1R rejection was associated with a 30% increased risk for subsequent major rejection. Among 28 patients classified as 1B/2 of the recurrent group, rejection scores were higher, while survival free of rejections was lower, compared to 37 patients of the recurrent group classified as 1A (5-year: 57.1% vs. 72.7%, p = 0.013). Kaplan-Meier analysis showed that CAV/CV mortality at 10 years of follow-up was significantly higher among the recurrent 1R group (38% vs. 18% p < 0.05). Multivariate analysis showed that early recurrent 1R rejections were associated with a 2.5-fold increased risk for CAV/CV mortality.

Conclusion

Early recurrent grade 1R rejections negatively affect long-term outcomes. The adverse outcomes are experienced mainly by 1R patients subcategorized as1B/2 and not 1A.



中文翻译:

心脏移植后早期复发的急性细胞排斥分级为ISHLT 1R对长期结果产生负面影响:1990 ISHLT 1B和2级的预后意义。

目的

我们调查了早期反复1R排斥反应对心脏移植(HT)后长期结局的影响,并评估了1990 ISHLT分级为1B / 2和1A的预后意义。

方法

回顾了1992年至2017年间所有接受HT治疗的患者的数据。在最初的3个月中,≥2例心内膜活检的患者被定为“复发1R”。根据1A和1B / 2对患者进行了进一步分类。结果(> 3个月)为长期排斥反应,以及同种异体移植血管病(CAV)和心血管(CV)死亡率的综合终点。

结果

228例患者中有69例归为复发1R级。在复发性1R组中,2R排斥率显着更高(2.6±0.6 vs 1.2±0.4,p  = 0.03),而无排斥生存率较低(5年:57.1%vs. 72.3%,p  = 0.022)。多变量分析表明,早期复发的1R排斥与随后的大排斥风险增加30%相关。与复发组分类为1A的37例患者相比,复发组分类为1B / 2的28例患者的排斥分数更高,无排斥生存率更低(5年:57.1%对72.7%,p = 0.013)。Kaplan-Meier分析显示,在复发的1R组中,随访10年的CAV / CV死亡率显着更高(38%对18%,p  <0.05)。多变量分析表明,早期复发性1R排斥与CAV / CV死亡风险增加2.5倍有关。

结论

早期复发的1R级排斥反应对长期预后产生负面影响。不良后果主要由1R / 2(而非1A)患者经历。

更新日期:2019-03-21
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