Humoral rejection in heart transplantation. Report of two cases

Heart transplantation is a therapeutic alternative for selected patients af ter transplantation. The cellular rejection is characterized by cellular in filtrates with or without miocyte necrosis. However, some patients develop left ventricular dysfunction due to antibodies and complement. Humoral reje ction is a relative rare but potentially fatal form of acute allograft reje ction. We report two patients with left ventricular dysfunction secondary t o humoral rejection, shortly after cardiac transplantation. Both patients w ere treated with methylprednisolone, and azathioprine was substituted by cy clophosphamide. One patient underwent plasmapheresis. The clinical outcome was satisfactory and the left ventricular function returned to normal in bo th cases. The diagnostic and therapeutic strategies for the management of h umoral rejection are reviewed (Rev Med Chile 2000; 128: 1245-49).