Clinicopathological Correlations in Heart Transplantation Recipients Complicated by Death or Re-Transplantation

Authors

Michelle M McDonald
Maks Mihalj
Bihong Zhao
Sriram Nathan
Stanislava Matejin
Giulia Ottaviani
Mateja K Jezovnik
Rajko Radovancevic
Biswajit Kar
Igor D Gregoric
L Maximilian Buja

Publication Date

1-1-2022

Journal

Frontiers in Cardiovascular Medicine

Abstract

PURPOSE: This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation.

METHODOLOGY AND STUDY DESIGN: Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were grouped according to the presence of AMI and compared.

RESULTS: We identified 47 patients with truncated outcomes after the first OHT. The median age was 59 years, 36 patients (76%) were male, 25 patients (53%) had a prior history of cardiac operation, and 21 patients (45%) were supported with a durable assist device before OHT. Of those, AMI was identified in 22 (47%) patients (AMI group), and 25 patients had no AMI (non-AMI group). Groups were comparable in baseline and perioperative data. Histopathological observations in AMI group included a non-significant higher incidence of antibody-mediated rejection Grade 1 or higher (pAMR ≥ 1) (32% vs. 12%,

CONCLUSION: In heart transplant recipients with a truncated postoperative course leading to either death or re-transplantation, AMI in endomyocardial biopsies was a common pathological phenomenon, which correlated with the clinical occurrence of severe primary graft dysfunction. Those patients had significantly shorter survival times and higher cardiac-related deaths. The presence of AMI suggests a truncated course after OHT.

Keywords

heart transplantation, endomyocardial biopsy, acute myocardial injury, primary graft dysfunction, rejection, cardiac allograft vasculopathy, C4d

Comments

PMID: 36407445