Acute cellular rejection the first year after heart transplantation and its impact on survival: a single centre retrospective study at skåne university hospital in lund 1988-2010.

Acute cellular rejection (ACR) the first year after heart transplantation (HT) and its impact on survival was investigated. All 215 HT-patients at our centre 1988-2010, including 219 HTs and 2990 1(st) -year endomyocardial biopsies (EMBs), were studied. "Routine"-EMBs obtained 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40 and 52 weeks after HT, and "additional clinically indicated" (ACI) EMBs, were graded according to the 1990 ISHLT-WF. The frequency and severity of 1(st) -year ACRs was low, with 6.5% of routine-EMBs and 14.1% of ACI-EMBs showing ACRs≥grade 2. Proportionally more (p<0.05) 1(st) -year ACRs≥grade 2 were found among; EMBs in HTs performed 1988-1999 (9.6%) than 2000-2010 (5.5%), EMBs performed 16-52 weeks (8.8%) than 1-12 weeks (6.3%) after HT, EMBs in HTs with pediatric (11.3%) than adult (7.1%) donors, and EMBs in sex-mismatched (10.4%) than sex-matched (6.3%) HTs. Five- and ten-year survival was furthermore lower (p<0.05) among HTs with ≥1 compared to 0 1(st) -year ACRs≥grade 3A/3B (82% vs. 92% and 69% vs. 82%, respectively). Ten-year survival was 74% compared to 53% in the ISHLT-registry. In conclusion, our results indicate that 1(st) -year ACRs≥grade 3A/3B affect long-term survival. We believe frequent 1(st) -year EMBs may allow early ACR-detection and continuous immunosuppressive adjustments, preventing progression of low-grade ACRs to ACRs≥grade 3A/3B, thereby improving survival. This article is protected by copyright. All rights reserved.