PERSISTENCE OF INTERSTITIAL INFLAMMATION AFTER EPISODES OF CARDIAC REJECTION ASSOCIATED WITH SYSTEMIC INFECTION

Background: To determine whether systemic infection has an effect on c ardiac allografts, we compared heart transplant biopsy specimens showi ng acute cardiac rejection in patients with and without associated sys temic infection. Methods: Systemic infection was defined as positive b acterial, viral, or fungal cultures with systemic symptoms such as sep sis, fever, or malaise, Patients were identified by chart review to ve rify the presence or absence of infection and the cardiac biopsy speci mens were examined for evidence of rejection. Eight patients (eight ep isodes of treated acute rejection) with evidence of systemic infection and 11 patients (14 episodes of treated acute rejection) without evid ence of systemic infection were identified. Results: Patients with rej ection and infection showed persistent interstitial inflammation longe r than patients with only rejection and was most often represented by International Society for Heart and Lung Transplantation rejection gra de 1B. Days to resolution or last biopsy was 20 to 602 days (mean 196 days) for patients with rejection and infection versus 15 to 133 days (mean 60 days) for patients with rejection alone, Results of two-taile d, unpaired t-test comparing the number of days of persistent inflamma tory infiltrates in the patients with acid without infection were stat istically significant (p = 0.0192). Conclusions: Heart transplant reci pients with treated acute rejection and systemic infection more freque ntly have persistent interstitial inflammatory infiltrates than do hea rt cardiac transplant recipients with treated acute rejection and no a ssociated infection. No impact of acute rejection or associated infect ion on the incidence of allograft coronary artery disease was apparent . Although further evaluation of these findings is necessary, we specu late that heart transplant recipients with systemic infection and acut e rejection have greater immunologic activity leading to persistent in terstitial inflammation and may possibly be associated with a higher i ncidence of chronic rejection.