Graft atherosclerosis after heart transplantation is a problem that may limit long-term survival. The objective of this study was to establish whether an association exists between graft atherosclerosis, cellular rejection, HLA compatibility, or antilymphocyte antibodies in recipient serum. Results of cineangiograms from 306 recipients were available. Life table and logistic regression analysis identified only a significant effect of cellular rejection on development of angiogram-evident graft vessel disease. A total of 146 allografts obtained at another transplantation or autopsy were also available. Coronary vessel narrowing was measured by planimetry. Linear regression with coronary narrowing as dependent variable established a positive association with history of cellular rejection. No effect was documented for panel reactive antibody level obtained before or after transplantation. We also did not show an impact of HLA mismatch on this process. The lack of HLA antigen effect prompts us to be cautious about linking graft atherosclerosis directly to the rejection event.

Adult↗

PubMedDate not supplied

Acute rejection and coronary artery disease in long-term survivors of heart transplantation.

The development of acute rejection and coronary artery disease (CAD) was studied in 173 patients who survived at least 1 year after orthotopic heart transplantation. There were 20 late deaths. The incidence of acute rejection found on endomyocardial biopsies after 1 year was 5.6%. Alteration in the immunosuppressive regimen accounted for 77% of the rejection episodes (chi-square = 9.3, F less than 0.01). Acute rejection without alteration in immunosuppressive therapy occurred only 1.4% of the time. CAD developed in 28 patients (16.2%). The prevalence of CAD was 5.8% at 1 year, 15.5% at 2 years, and increased to 66% at 6 years. Patients developing CAD had 0.5 (+/- 0.8) rejection episodes after 1 year as opposed to 0.2 (+/- 0.5) rejection episodes in patients with no CAD (S1 less than 0.01 by Mann-Whitney). There was no difference in the number of rejection episodes during the first year. The total number of rejection episodes was 1.9 (+/- 1.6) and 1.2 (+/- 1.2) in patients with and without CAD, respectively (S1 less than 0.03 by Mann-Whitney). Diabetes mellitus was present in 25% of patients with CAD and 16.5% of patients without CAD (chi-square = 3.14, F less than 0.1). Acute rejection rarely occurs after 1 year and is usually caused by an alteration in the immunosuppressive regimen. CAD develops with increasing frequency and is correlated with rejection episodes and diabetes mellitus.

Adult↗

PubMedDate not supplied

Moderate dementia and multiple disabilities.

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Aged↗

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Bankable assets.

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Corneal Transplantation↗