Faculty Collaboration Database

Risk of early, intermediate, and late rejection following heart transplantation: Trends over the past 25 years and relation to changes in medical management. Tertiary center experience: The Sheba Heart Transplantation Registry. Clin Transplant 2017 Oct;31(10)

Date

07/29/2017

Pubmed ID

28753240

DOI

10.1111/ctr.13063

Scopus ID

2-s2.0-85030705328 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

AIM: To explore the trends in the risk for rejection following heart transplantation (HT) over the past 25 years, and their relation to changes in medical management.

METHODS: The study population comprised 216 HT patients. Rejection periods were defined as follows: 0-3 months (early), 3-12 months (intermediate), and 12+ months (late). HT era was dichotomized as follows: 1991-1999 (remote era) and 2000-2016 (recent era). Medication combination was categorized as newer (TAC, MMF, and everolimus) vs older therapies (AZA, CSA).

RESULTS: Multivariate analysis showed that patients who underwent HT during the recent era experienced a significant reduction in the risk for major rejection. These findings were consistent for early (OR = 0.44 [95% CI 0.22-0.88]), intermediate (OR = 0.02 [95% CI 0.003-0.11]), and late rejections (OR = 0.18 [95% CI 0.05-0.52]). Using the year of HT as a continuous measure showed that each 1-year increment was independently associated with a significant reduction in the risk for early, intermediate, and late rejections (5%, 21%, 18%, respectively). In contrast, the risk reduction associated with newer types of immunosuppressive therapies was not statistically significant after adjustment for the treatment period.

CONCLUSIONS: Major rejection rates following HT have significantly declined over the past 2 decades even after adjustment for changes in immunosuppressive therapies, suggesting that other factors may also play a role in the improved outcomes of HT recipients.

Author List

Katz M, Freimark D, Raichlin E, Har-Zahav Y, Arad M, Kassif Y, Peled A, Asher E, Elian D, Kogan A, Shlomo N, Ofek E, Lavee J, Goldenberg I, Peled Y

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Heart Transplantation
Humans
Immunosuppressive Agents
Male
Middle Aged
Postoperative Complications
Prognosis
Registries
Risk Factors
Tertiary Care Centers