Abstract
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.
Methods
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.
Results
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.
Conclusions
Plasmapheresis seems to improve outcomes in HRHC. However, cyclophosphamide as a maintenance
immunosuppressive drug failed to prevent further humoral rejection episodes.
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Article info
Publication history
Accepted:
August 31,
2000
Received:
May 1,
2000
Identification
Copyright
© 2001 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
