Impact of repetitive episodes of antibody-mediated or cellular rejection on cardiovascular mortality in cardiac transplant recipients: defining rejection patterns
| Autor: | Gregory L. Snow, Edward M. Gilbert, James Seaman, M. Elizabeth H. Hammond, James S. Stringham, Dale G. Renlund, Josef Stehlik, James W. Long, Abdallah G. Kfoury |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Graft Rejection Male medicine.medical_specialty Endpoint Determination medicine.medical_treatment Biopsy Kaplan-Meier Estimate Internal medicine Epidemiology Medicine Humans Transplantation Homologous Survival analysis Retrospective Studies Immunosuppression Therapy Transplantation medicine.diagnostic_test business.industry Respiratory disease Retrospective cohort study Immunosuppression Middle Aged medicine.disease Prognosis Surgery Clinical trial Treatment Outcome Heart Transplantation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 25(11) |
| ISSN: | 1557-3117 |
| Popis: | Background In our previously published work dealing with antibody-mediated (vascular) rejection (AMR), we defined patterns of rejection (AMR and cellular rejection [CR]) based on a review of biopsy diagnoses taken in the first 6 to 12 weeks post-transplant. We have shown the significance of these pattern designations in relation to patient and allograft outcome in five outcome analyses. The current retrospective analysis was done to determine whether our previous criteria for pattern designations provided the greatest degree of discrimination between AMR and CR. Methods Six hundred sixty-five patients from the U.T.A.H. Cardiac Transplant Program were included in our study. Patients induced with OKT3 immunosuppression were excluded. We analyzed the relationship of a number of either AMR or CR episodes to cardiovascular mortality. We constructed Kaplan–Meier survival curves to assess the impact of incremental numbers of AMR or CR episodes on cardiovascular mortality. Results Three or more episodes of AMR resulted in a statistically significant increase in cardiovascular mortality. By contrast, CR episodes did not increase the risk of cardiovascular mortality. Conclusions Based on our findings, we believe that clinical trials should be designed to test treatments based on predominant rejection patterns and that end-points for trials should be defined by number of biopsies positive for either CR or AMR. This approach may lead to improved patient and allograft survival. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|