M. Anguita et al., REPETITIVE NONTREATED EPISODES OF GRADE-1B OR GRADE-2 ACUTE REJECTIONIMPAIR LONG-TERM CARDIAC GRAFT FUNCTION, The Journal of heart and lung transplantation, 14(3), 1995, pp. 452-460
Background: Episodes of grade 1B or 2 acute heart rejection are usuall
y not treated, and most of them resolve spontaneously. Methods: With t
he aim to assess long-term outcome in patients with repetitive nontrea
ted episodes of low-grade (1B, 2) acute rejection, we have studied 141
heart transplant recipients in whom the evolutive pattern of acute re
jection during the first 6 months after transplantation could be deter
mined. Results: Forty-four patients (31%) had only grade 0 or 1A acute
rejection episodes (pattern A); 23 patients (16%) had three or more e
pisodes of grade 1B or 2 acute rejection without 3A or more advanced r
ejection (pattern B); 48 patients (34%) had one or two episodes of gra
de 3A, 3B, or 4 acute rejection only during the first 6 months after t
ransplantation (pattern C); and 26 patients (19%) had three or more ep
isodes of grade 3A, 3B, or 4 acute rejection (pattern D). Overall mort
ality was 11%, 26%, 19%, and 46% for patients with patterns A, B, C, a
nd D, respectively. No difference was found among patterns with regard
to incidence of graft atherosclerosis. Left ventricular ejection frac
tion at 1 year after transplantation was significantly lower (p < 0.05
) for patients with pattern B (50% +/- 5% versus 59% +/- 7%, 59% +/- 1
1%, and 56% +/- 6% for patterns A, C, and D, respectively); cardiac in
dex also was lower for patients with pattern B than for those with pat
tern A (3.6 +/- 0.6 versus 4.1 +/- 0.6 L/min/m(2), p < 0.05). Conclusi
ons: Although mortality was higher for patients with more severe episo
des of acute rejection, only repetitive nontreated episodes of grade 1
B or 2 rejection significantly impaired long-term graft function.