Heart transplant rejection with hemodynamic compromise

A multiinstitutional study of the role of endomyocardial cellular infiltrate

R. M. Mills, D. C. Naftel, J. K. Kirklin, A. B. Van Bakel, B. E. Jaski, E. K. Massin, H. J. Eisen, F. A. Lee, D. P. Fishbein, R. C. Bourge, D. C. McGiffin, T. Weiss, A. Crosswyt, B. Austin, L. Early, P. Holmes, M. Veazey, P. Sims, K. Hubbard, J. Brush & 77 others M. R. Pritzker, K. D. Lake, M. O'Kane, S. Chapman, F. Hoffman, N. Seimers, C. Jorgensen, W. Pedersen, L. Joyce, F. Eales, R. W. Emery, T. Von Reuden, P. Bruhn, M. King, K. Arom, K. J. Hellman, D. Pacheco, C. Moore, S. Levin, P. Blair, G. H. Mudge, J. Jarcho, P. Johnson, E. Loh, R. E. Hobbs, G. Rincon, C. Bott-Silverman, P. McCarthy, R. Stewart, L. Platt, Robert E. Michler, E. M. Burke, R. Gomez, F. Hoy, D. Gels, J. Munss, D. Best, B. Clemson, P. McRae, C. Stables, S. Faulkner, M. L. Stenstrom, Jr Mills R.M., S. Selman, C. McGinn, T. Walker, J. Pooser, T. B. Levine, A. B. Levine, B. Narins, J. Boehmer, P. Frazier, P. Coe, S. C. Brozena, J. M. Fitzpatrick, A. K. Gash, D. Chojnowski, J. Kozak, P. Stutman, C. Twomey, D. Stinson, T. Flaspholer, M. R. Costanzo, M. Johnson, W. Kao, E. Winkel, G. M. Mullen, A. Heroux, C. P. Porter, A. M. Borkon, D. R. Bresnanhan, R. E. Genton, N. D. Long, S. K. Rowe, E. H. Rusell, D. Tolman, H. Ibrahim

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Background: The natural history of patients experiencing hemodynamic compromise with rejection has been incompletely characterized. This multiinstitutional study examined the outcome of such episodes, particularly with regard to the extent of cellular infiltrate on the index endomyocardial biopsy. Methods: From January 1, 1990, through June 30, 1994, 3367 patients in the Cardiac Transplant Research Database experienced 4137 episodes of rejection. Severe hemodynamic compromise occurred in approximately 5% of the rejection episodes, and this proportion remained relatively constant over time. Results: Recipient risk factors for rejection with severe hemodynamic compromise included black race, female recipient sex, and diabetes. The 3- month actuarial survival rate was 60% after rejection with severe hemodynamic compromise versus 95% after rejection with no or mild compromise. Low initial biopsy score conferred a higher early survival, but a lower survival at 2 years after rejection with severe hemodynamic compromise. Among patients who survive an initial rejection episode with severe hemodynamic compromise, survival at 2 years after an episode was 46% among those who had a low initial biopsy score versus 84% with a high biopsy score. Conclusions: Rejection with hemodynamic compromise, although rare, represents a major complication of heart transplantation with a poor long-term outcome. Survivors of hemodynamically compromising rejection episodes associated with low biopsy scores in the International Society for Heart and Lung Transplantation grading system have a significantly worse long-term outcome than survivors of episodes associated with high scores. These findings suggest that immunologic mechanisms other than lymphocytic infiltration of the cardiac allograft are important and distinct causes of allograft dysfunction.

Original languageEnglish (US)
Pages (from-to)813-821
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume16
Issue number8
StatePublished - 1997
Externally publishedYes

Fingerprint

Graft Rejection
Hemodynamics
Biopsy
Allografts
Survival
Survivors
Heart Transplantation
Natural History
Survival Rate
Outcome Assessment (Health Care)
Databases
Transplants
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Mills, R. M., Naftel, D. C., Kirklin, J. K., Van Bakel, A. B., Jaski, B. E., Massin, E. K., ... Ibrahim, H. (1997). Heart transplant rejection with hemodynamic compromise: A multiinstitutional study of the role of endomyocardial cellular infiltrate. Journal of Heart and Lung Transplantation, 16(8), 813-821.

Heart transplant rejection with hemodynamic compromise : A multiinstitutional study of the role of endomyocardial cellular infiltrate. / Mills, R. M.; Naftel, D. C.; Kirklin, J. K.; Van Bakel, A. B.; Jaski, B. E.; Massin, E. K.; Eisen, H. J.; Lee, F. A.; Fishbein, D. P.; Bourge, R. C.; McGiffin, D. C.; Weiss, T.; Crosswyt, A.; Austin, B.; Early, L.; Holmes, P.; Veazey, M.; Sims, P.; Hubbard, K.; Brush, J.; Pritzker, M. R.; Lake, K. D.; O'Kane, M.; Chapman, S.; Hoffman, F.; Seimers, N.; Jorgensen, C.; Pedersen, W.; Joyce, L.; Eales, F.; Emery, R. W.; Von Reuden, T.; Bruhn, P.; King, M.; Arom, K.; Hellman, K. J.; Pacheco, D.; Moore, C.; Levin, S.; Blair, P.; Mudge, G. H.; Jarcho, J.; Johnson, P.; Loh, E.; Hobbs, R. E.; Rincon, G.; Bott-Silverman, C.; McCarthy, P.; Stewart, R.; Platt, L.; Michler, Robert E.; Burke, E. M.; Gomez, R.; Hoy, F.; Gels, D.; Munss, J.; Best, D.; Clemson, B.; McRae, P.; Stables, C.; Faulkner, S.; Stenstrom, M. L.; Mills R.M., Jr; Selman, S.; McGinn, C.; Walker, T.; Pooser, J.; Levine, T. B.; Levine, A. B.; Narins, B.; Boehmer, J.; Frazier, P.; Coe, P.; Brozena, S. C.; Fitzpatrick, J. M.; Gash, A. K.; Chojnowski, D.; Kozak, J.; Stutman, P.; Twomey, C.; Stinson, D.; Flaspholer, T.; Costanzo, M. R.; Johnson, M.; Kao, W.; Winkel, E.; Mullen, G. M.; Heroux, A.; Porter, C. P.; Borkon, A. M.; Bresnanhan, D. R.; Genton, R. E.; Long, N. D.; Rowe, S. K.; Rusell, E. H.; Tolman, D.; Ibrahim, H.

In: Journal of Heart and Lung Transplantation, Vol. 16, No. 8, 1997, p. 813-821.

Research output: Contribution to journalArticle

Mills, RM, Naftel, DC, Kirklin, JK, Van Bakel, AB, Jaski, BE, Massin, EK, Eisen, HJ, Lee, FA, Fishbein, DP, Bourge, RC, McGiffin, DC, Weiss, T, Crosswyt, A, Austin, B, Early, L, Holmes, P, Veazey, M, Sims, P, Hubbard, K, Brush, J, Pritzker, MR, Lake, KD, O'Kane, M, Chapman, S, Hoffman, F, Seimers, N, Jorgensen, C, Pedersen, W, Joyce, L, Eales, F, Emery, RW, Von Reuden, T, Bruhn, P, King, M, Arom, K, Hellman, KJ, Pacheco, D, Moore, C, Levin, S, Blair, P, Mudge, GH, Jarcho, J, Johnson, P, Loh, E, Hobbs, RE, Rincon, G, Bott-Silverman, C, McCarthy, P, Stewart, R, Platt, L, Michler, RE, Burke, EM, Gomez, R, Hoy, F, Gels, D, Munss, J, Best, D, Clemson, B, McRae, P, Stables, C, Faulkner, S, Stenstrom, ML, Mills R.M., J, Selman, S, McGinn, C, Walker, T, Pooser, J, Levine, TB, Levine, AB, Narins, B, Boehmer, J, Frazier, P, Coe, P, Brozena, SC, Fitzpatrick, JM, Gash, AK, Chojnowski, D, Kozak, J, Stutman, P, Twomey, C, Stinson, D, Flaspholer, T, Costanzo, MR, Johnson, M, Kao, W, Winkel, E, Mullen, GM, Heroux, A, Porter, CP, Borkon, AM, Bresnanhan, DR, Genton, RE, Long, ND, Rowe, SK, Rusell, EH, Tolman, D & Ibrahim, H 1997, 'Heart transplant rejection with hemodynamic compromise: A multiinstitutional study of the role of endomyocardial cellular infiltrate', Journal of Heart and Lung Transplantation, vol. 16, no. 8, pp. 813-821.
Mills, R. M. ; Naftel, D. C. ; Kirklin, J. K. ; Van Bakel, A. B. ; Jaski, B. E. ; Massin, E. K. ; Eisen, H. J. ; Lee, F. A. ; Fishbein, D. P. ; Bourge, R. C. ; McGiffin, D. C. ; Weiss, T. ; Crosswyt, A. ; Austin, B. ; Early, L. ; Holmes, P. ; Veazey, M. ; Sims, P. ; Hubbard, K. ; Brush, J. ; Pritzker, M. R. ; Lake, K. D. ; O'Kane, M. ; Chapman, S. ; Hoffman, F. ; Seimers, N. ; Jorgensen, C. ; Pedersen, W. ; Joyce, L. ; Eales, F. ; Emery, R. W. ; Von Reuden, T. ; Bruhn, P. ; King, M. ; Arom, K. ; Hellman, K. J. ; Pacheco, D. ; Moore, C. ; Levin, S. ; Blair, P. ; Mudge, G. H. ; Jarcho, J. ; Johnson, P. ; Loh, E. ; Hobbs, R. E. ; Rincon, G. ; Bott-Silverman, C. ; McCarthy, P. ; Stewart, R. ; Platt, L. ; Michler, Robert E. ; Burke, E. M. ; Gomez, R. ; Hoy, F. ; Gels, D. ; Munss, J. ; Best, D. ; Clemson, B. ; McRae, P. ; Stables, C. ; Faulkner, S. ; Stenstrom, M. L. ; Mills R.M., Jr ; Selman, S. ; McGinn, C. ; Walker, T. ; Pooser, J. ; Levine, T. B. ; Levine, A. B. ; Narins, B. ; Boehmer, J. ; Frazier, P. ; Coe, P. ; Brozena, S. C. ; Fitzpatrick, J. M. ; Gash, A. K. ; Chojnowski, D. ; Kozak, J. ; Stutman, P. ; Twomey, C. ; Stinson, D. ; Flaspholer, T. ; Costanzo, M. R. ; Johnson, M. ; Kao, W. ; Winkel, E. ; Mullen, G. M. ; Heroux, A. ; Porter, C. P. ; Borkon, A. M. ; Bresnanhan, D. R. ; Genton, R. E. ; Long, N. D. ; Rowe, S. K. ; Rusell, E. H. ; Tolman, D. ; Ibrahim, H. / Heart transplant rejection with hemodynamic compromise : A multiinstitutional study of the role of endomyocardial cellular infiltrate. In: Journal of Heart and Lung Transplantation. 1997 ; Vol. 16, No. 8. pp. 813-821.
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title = "Heart transplant rejection with hemodynamic compromise: A multiinstitutional study of the role of endomyocardial cellular infiltrate",
abstract = "Background: The natural history of patients experiencing hemodynamic compromise with rejection has been incompletely characterized. This multiinstitutional study examined the outcome of such episodes, particularly with regard to the extent of cellular infiltrate on the index endomyocardial biopsy. Methods: From January 1, 1990, through June 30, 1994, 3367 patients in the Cardiac Transplant Research Database experienced 4137 episodes of rejection. Severe hemodynamic compromise occurred in approximately 5{\%} of the rejection episodes, and this proportion remained relatively constant over time. Results: Recipient risk factors for rejection with severe hemodynamic compromise included black race, female recipient sex, and diabetes. The 3- month actuarial survival rate was 60{\%} after rejection with severe hemodynamic compromise versus 95{\%} after rejection with no or mild compromise. Low initial biopsy score conferred a higher early survival, but a lower survival at 2 years after rejection with severe hemodynamic compromise. Among patients who survive an initial rejection episode with severe hemodynamic compromise, survival at 2 years after an episode was 46{\%} among those who had a low initial biopsy score versus 84{\%} with a high biopsy score. Conclusions: Rejection with hemodynamic compromise, although rare, represents a major complication of heart transplantation with a poor long-term outcome. Survivors of hemodynamically compromising rejection episodes associated with low biopsy scores in the International Society for Heart and Lung Transplantation grading system have a significantly worse long-term outcome than survivors of episodes associated with high scores. These findings suggest that immunologic mechanisms other than lymphocytic infiltration of the cardiac allograft are important and distinct causes of allograft dysfunction.",
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year = "1997",
language = "English (US)",
volume = "16",
pages = "813--821",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
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TY - JOUR

T1 - Heart transplant rejection with hemodynamic compromise

T2 - A multiinstitutional study of the role of endomyocardial cellular infiltrate

AU - Mills, R. M.

AU - Naftel, D. C.

AU - Kirklin, J. K.

AU - Van Bakel, A. B.

AU - Jaski, B. E.

AU - Massin, E. K.

AU - Eisen, H. J.

AU - Lee, F. A.

AU - Fishbein, D. P.

AU - Bourge, R. C.

AU - McGiffin, D. C.

AU - Weiss, T.

AU - Crosswyt, A.

AU - Austin, B.

AU - Early, L.

AU - Holmes, P.

AU - Veazey, M.

AU - Sims, P.

AU - Hubbard, K.

AU - Brush, J.

AU - Pritzker, M. R.

AU - Lake, K. D.

AU - O'Kane, M.

AU - Chapman, S.

AU - Hoffman, F.

AU - Seimers, N.

AU - Jorgensen, C.

AU - Pedersen, W.

AU - Joyce, L.

AU - Eales, F.

AU - Emery, R. W.

AU - Von Reuden, T.

AU - Bruhn, P.

AU - King, M.

AU - Arom, K.

AU - Hellman, K. J.

AU - Pacheco, D.

AU - Moore, C.

AU - Levin, S.

AU - Blair, P.

AU - Mudge, G. H.

AU - Jarcho, J.

AU - Johnson, P.

AU - Loh, E.

AU - Hobbs, R. E.

AU - Rincon, G.

AU - Bott-Silverman, C.

AU - McCarthy, P.

AU - Stewart, R.

AU - Platt, L.

AU - Michler, Robert E.

AU - Burke, E. M.

AU - Gomez, R.

AU - Hoy, F.

AU - Gels, D.

AU - Munss, J.

AU - Best, D.

AU - Clemson, B.

AU - McRae, P.

AU - Stables, C.

AU - Faulkner, S.

AU - Stenstrom, M. L.

AU - Mills R.M., Jr

AU - Selman, S.

AU - McGinn, C.

AU - Walker, T.

AU - Pooser, J.

AU - Levine, T. B.

AU - Levine, A. B.

AU - Narins, B.

AU - Boehmer, J.

AU - Frazier, P.

AU - Coe, P.

AU - Brozena, S. C.

AU - Fitzpatrick, J. M.

AU - Gash, A. K.

AU - Chojnowski, D.

AU - Kozak, J.

AU - Stutman, P.

AU - Twomey, C.

AU - Stinson, D.

AU - Flaspholer, T.

AU - Costanzo, M. R.

AU - Johnson, M.

AU - Kao, W.

AU - Winkel, E.

AU - Mullen, G. M.

AU - Heroux, A.

AU - Porter, C. P.

AU - Borkon, A. M.

AU - Bresnanhan, D. R.

AU - Genton, R. E.

AU - Long, N. D.

AU - Rowe, S. K.

AU - Rusell, E. H.

AU - Tolman, D.

AU - Ibrahim, H.

PY - 1997

Y1 - 1997

N2 - Background: The natural history of patients experiencing hemodynamic compromise with rejection has been incompletely characterized. This multiinstitutional study examined the outcome of such episodes, particularly with regard to the extent of cellular infiltrate on the index endomyocardial biopsy. Methods: From January 1, 1990, through June 30, 1994, 3367 patients in the Cardiac Transplant Research Database experienced 4137 episodes of rejection. Severe hemodynamic compromise occurred in approximately 5% of the rejection episodes, and this proportion remained relatively constant over time. Results: Recipient risk factors for rejection with severe hemodynamic compromise included black race, female recipient sex, and diabetes. The 3- month actuarial survival rate was 60% after rejection with severe hemodynamic compromise versus 95% after rejection with no or mild compromise. Low initial biopsy score conferred a higher early survival, but a lower survival at 2 years after rejection with severe hemodynamic compromise. Among patients who survive an initial rejection episode with severe hemodynamic compromise, survival at 2 years after an episode was 46% among those who had a low initial biopsy score versus 84% with a high biopsy score. Conclusions: Rejection with hemodynamic compromise, although rare, represents a major complication of heart transplantation with a poor long-term outcome. Survivors of hemodynamically compromising rejection episodes associated with low biopsy scores in the International Society for Heart and Lung Transplantation grading system have a significantly worse long-term outcome than survivors of episodes associated with high scores. These findings suggest that immunologic mechanisms other than lymphocytic infiltration of the cardiac allograft are important and distinct causes of allograft dysfunction.

AB - Background: The natural history of patients experiencing hemodynamic compromise with rejection has been incompletely characterized. This multiinstitutional study examined the outcome of such episodes, particularly with regard to the extent of cellular infiltrate on the index endomyocardial biopsy. Methods: From January 1, 1990, through June 30, 1994, 3367 patients in the Cardiac Transplant Research Database experienced 4137 episodes of rejection. Severe hemodynamic compromise occurred in approximately 5% of the rejection episodes, and this proportion remained relatively constant over time. Results: Recipient risk factors for rejection with severe hemodynamic compromise included black race, female recipient sex, and diabetes. The 3- month actuarial survival rate was 60% after rejection with severe hemodynamic compromise versus 95% after rejection with no or mild compromise. Low initial biopsy score conferred a higher early survival, but a lower survival at 2 years after rejection with severe hemodynamic compromise. Among patients who survive an initial rejection episode with severe hemodynamic compromise, survival at 2 years after an episode was 46% among those who had a low initial biopsy score versus 84% with a high biopsy score. Conclusions: Rejection with hemodynamic compromise, although rare, represents a major complication of heart transplantation with a poor long-term outcome. Survivors of hemodynamically compromising rejection episodes associated with low biopsy scores in the International Society for Heart and Lung Transplantation grading system have a significantly worse long-term outcome than survivors of episodes associated with high scores. These findings suggest that immunologic mechanisms other than lymphocytic infiltration of the cardiac allograft are important and distinct causes of allograft dysfunction.

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VL - 16

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EP - 821

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

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