Higher frequency of high-grade rejections in cardiac allograft patients after Quilty B lesions or grade 2/4 rejections.

Abstract:

BACKGROUND:To better understand how different histologic patterns of allograft inflammation found on biopsies of human cardiac allografts progress to high-grade rejection, we undertook a statistical analysis of our institutional database to detect statistical patterns among different types of myocardial allograft inflammations found on sequential biopsies. METHODS:Biopsies were analyzed for statistical associations between high-grade rejections (International Society of Heart and Lung Transplantation [ISHLT] grade > or = 3A/4) and the type of cardiac allograft inflammation found on prior biopsies. Case cross-over and case control designs were used to compare the antecedent patterns of inflammation on biopsies with high-grade rejection compared to biopsies with low-grade rejection, all within the same subject. Quilty lesions were correlated with cyclosporine levels. RESULTS:Patients with Quilty B lesions or ISHLT grade 2/4 rejections show an increased risk for high-grade rejection on their next biopsies (Odds ratio 5.9 to 11.2). The presence of two pathological findings, especially Quilty B and grade 2/4 rejection, creates additional risk in excess of that found independently (Odds ratio >14). Quilty lesions are found only in cardiac allografts, and do not correlate with trough cyclosporine levels. CONCLUSIONS:The morphological patterns of several types of human cardiac allograft inflammation found on sequential protocol biopsies are not randomly associated. Patients with grade 2/4 rejections and Quilty B lesions show an increased risk for high-grade rejections on their next biopsies. Quilty B lesions, similar to ISHLT grade 2/4 rejections, may represent subclinical rejection. Both are more likely to progress to a high-grade rejection.

journal_name

Transplantation

journal_title

Transplantation

authors

Smith RN,Chang Y,Houser S,Dec GW,Grazette L

doi

10.1097/00007890-200206270-00014

subject

Has Abstract

pub_date

2002-06-27 00:00:00

pages

1928-32

issue

12

eissn

0041-1337

issn

1534-6080

journal_volume

73

pub_type

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