Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Antibody-mediated rejection - a major complication after heart transplantation
Session:
Comunicações Orais - Sessão 14 - Transplante cardíaco
Speaker:
Sandra Maria Resende Amorim
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.8 Cardiovascular Surgery - Transplantation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sandra Amorim; Pedro Rodrigues Pereira; Roberto Pinto; Paulo Araújo; José Pinheiro Torres; Marta Andrade; Sandra Tafulo; José Silva Cardoso; Filipe Macedo; Paulo Pinho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Acute cellular rejection is the mechanism of most immune-related injury in cardiac transplant recipients. However, antibody-mediated rejection (AMR) is gaining increasing recognition as a major complication after heart transplantation (HT) associated with increased mortality and cardiac allograft vasculopathy (CAV). AMR results from activation of the humoral immune arm and the production of donor-specific antibodies (DSA) that bind to the cardiac allograft causing myocardial injury predominantly through complement activation. We sought to investigate the prevalence and predictors of AMR and its association with graft dysfunction, mortality, and CAV.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Prospective cohort study, from 2016 to 2021, with 71 adult heart transplant recipients (excluded pts with hospital mortality, not due to rejection) with endomyocardial biopsies searching for AMR according to ISHLT grading: histologic findings and immunofluorescence for C4d. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: AMR was present in 20 pts (28.2 %). 7 had early AMR (< 1 y of HT) and 13 had late AMR (median 77 months post-HT). 18 pts had AMR1, 1 had AMR2 and in 1 pt diagnosis of AMR was made by severe allograft dysfunction combined with DSA and high titters of C1q-binding antibodies. DSA were detected in 66% and 7 pts (35%) had concurrent acute cellular rejection. Graft dysfunction occurred in 9 pts (45%, all late AMR). 5 pts received intravenous methylprednisolone, 3 received IVIg, 3 received plasmapheresis, 2 received rituximab, 7 received high dose of oral prednisolone and 5 pts received optimization of immunosuppressive therapy. Prognosis of pts with graft disfunction was poor (20% death/ retransplant): cardiac death in 2 pts , infection in 1 pt and retransplant in 1 pt. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pts with AMR were more likely to have anti-HLA antibodies before HT (90.9% vs 53.9%, p=0.03), graft dysfunction (40.0% vs 3.9% ), acute cellular rejection episodes (≥ 2R ISHLT) ( 90.0% vs 54%.0, p<0.01), acute cellular rejection <1 year post-HT (80.0% vs 36.0%, p<0.01) than those without AMR. No association was found between CAV, age, female gender, ECMO use and presence of AMR. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Overall survival at 5 and 10 years was not different in pts with or without AMR. At 12 y there was a decrease in survival (57% vs 79%) in pts with AMR.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: Late AMR is frequently associated with graft dysfunction and an increased risk of mortality. Early diagnosis and treatment of AMR, particularly in those with pre-HT alossensibilization or with episodes of cellular rejection, may therefore be important to reduce the consequences of chronic inflammation leading to development of myocardial fibrosis and graft dysfunction.</span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site