Background: Clinical reports on humoral rejection after heart transplantation showed that these episodes were often more severe than those mediated through T lymphocytes and that the patient’s prognosis was significantly worsened.
To evaluate the impact of plasmapheresis on the course of humoral rejection with hemodynamic compromise (HRHC) episodes, we retrospectively investigated the records of 1,108 heart transplant patients. All patients received triple-drug immunosuppression (cyclosporine a, azathioprine, prednisone) and cytolytic antibodies for induction. Between April 1986 and December 1990, HRHC episodes were treated with cortisone boli and cytolytic antibodies for at least 3 days (Group A). Between January 1991 and April 1999, HRHC episodes were treated with cortisone boli, cytolytic antibodies, and plasmapheresis for at least 3 days (Group B). All patients who survived their first HRHC episode received cyclophosphamide instead of azathioprine as maintenance immunosuppression.
Altogether we observed 29 HRHC episodes. In 11 cases, no therapy could be administered or the therapy regimen did not correspond to either Protocol A or B. In the remaining 18 HRHC episodes, 7 episodes in 7 patients were treated without plasmapheresis (Group A), but only 2 patients survived, whereas in 11 HRHC episodes in 6 patients, therapy included plasmapheresis (Group B) and all patients survived (p = 0.002). Four of 6 patients who received cyclophosphamide after their first HRHC episode experienced at least 1 further HRHC episode.
Plasmapheresis seems to improve outcomes in HRHC. However, cyclophosphamide as a maintenance immunosuppressive drug failed to prevent further humoral rejection episodes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Heart and Lung Transplantation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Passive transfer of transplantation immunity.Proc R Soc Lond. 1954; 142: 72
- Passive transfer of transplantation immunity.J Exp Med. 1962; 115: 1083
- Heart-reactive antibody.Circulation. 1970; 42: 91
- Percutaneous transvenous endomyocardial biopsy in human heart recipients.Ann Thorac Surg. 1973; 16: 125
- Diagnosis of cardiac rejection by endomyocardial biopsy.J Heart Transplant. 1981; 1: 25
- Acute humoral rejection after heart transplantation.Transplantation. 1988; 46: 603
- Vascular (humoral) rejection in heart transplantation.J Heart Transplant. 1989; 8: 430
- Immunofluorescence of endomyocardial biopsy specimens.J Heart Lung Transplant. 1993; 12: S113
- Vascular (humoral) rejection in human cardiac allograft biopsies.J Heart Transplant. 1992; 11: 24-30
- Clinical manifestations of vascular rejection in cardiac transplantation.Transplant Proc. 1991; 23: 1130
- Vascular rejection in heart transplant recipients.J Heart Transplant. 1993; 12: S147-S152
- Vascular rejection in heart transplantation.J Heart Transplant. 1993; 12: S135-S142
- Successful treatment of acute humoral rejection in a heart transplant patient.J Heart Transplant. 1992; 11: 486-491
- Heart transplant rejection treated with plasmapheresis.J Heart Transplant. 1992; 11: 301-305
- Outcome of cardiac transplant recipients with a positive donor-specific crossmatch.Transplantation. 1992; 54: 651-655
- Plasmapheresis in the treatment of posttransplant cardiomyopathy.Artif Organs. 1998; 22: 197-202
- Plasmapheresis as a therapy to resolve vascular rejection in heart transplantation with severe heart failure.Transplant Proc. 1998; 30: 176-179
- Apheresis in thoracic organ transplantation.Ther Apher. 1999; 3: 34-39
- Accelerated course of cardiac allograft rejection after mechanical bridging.J Heart Transpl. 1990; 9: 58
- Impact of apheresis and cyclophosphamide in the treatment of vascular rejection following heart transplantation.J Heart Lung Transplant. 1994; 13: S74
Grauhan O, Müller J, v. Baeyer H, et al. Treatment of humoral rejection after heart transplantation. J Heart Lung Transplant 1998;17:1184–94.
- A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection.J Heart Lung Transplant. 1990; 10: 587-593
- Clinical heart transplantation without routine endomyocardial biopsy.J Heart Lung Transplant. 1992; 11: 1093-1102
- Humoral rejection after heart transplantation.Transpl Int. 1997; 10: 439-445
- Intramyocardial electrogram recordings for diagnosis and therapy monitoring of cardiac allograft rejection.Eur J Cardiothorac Surg. 1993; 7: 489-494
- Early diastolic left ventricular function as a marker of acute cardiac rejection.Int J Cardiol. 1992; 37: 351-359
Accepted: August 31, 2000
Received: May 1, 2000
© 2001 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.