Impact of repetitive episodes of antibody-mediated or cellular rejection on cardiovascular mortality in cardiac transplant recipients: defining rejection patterns. Export

@article{citeulike:1042942, abstract = {BACKGROUND: In our previously published work dealing with antibody-mediated (vascular) rejection (AMR), we defined patterns of rejection (AMR and cellular rejection [CR]) based on a review of biopsy diagnoses taken in the first 6 to 12 weeks post-transplant. We have shown the significance of these pattern designations in relation to patient and allograft outcome in five outcome analyses. The current retrospective analysis was done to determine whether our previous criteria for pattern designations provided the greatest degree of discrimination between AMR and CR. METHODS: Six hundred sixty-five patients from the U.T.A.H. Cardiac Transplant Program were included in our study. Patients induced with OKT3 immunosuppression were excluded. We analyzed the relationship of a number of either AMR or CR episodes to cardiovascular mortality. We constructed Kaplan-Meier survival curves to assess the impact of incremental numbers of AMR or CR episodes on cardiovascular mortality. RESULTS: Three or more episodes of AMR resulted in a statistically significant increase in cardiovascular mortality. By contrast, CR episodes did not increase the risk of cardiovascular mortality. CONCLUSIONS: Based on our findings, we believe that clinical trials should be designed to test treatments based on predominant rejection patterns and that end-points for trials should be defined by number of biopsies positive for either CR or AMR. This approach may lead to improved patient and allograft survival.}, address = {LDS Hospital, Intermountain Health Care, Salt Lake City, Utah 84143, USA.}, author = {Kfoury, A. G. and Stehlik, J. and Renlund, D. G. and Snow, G. and Seaman, J. T. and Gilbert, E. M. and Stringham, J. S. and Long, J. W. and Hammond, M. E.}, citeulike-article-id = {1042942}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.healun.2006.08.009}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/17097489}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=17097489}, doi = {10.1016/j.healun.2006.08.009}, issn = {1557-3117}, journal = {J Heart Lung Transplant}, keywords = {biopsy, humoral, rejection}, month = {November}, number = {11}, pages = {1277--1282}, posted-at = {2007-01-15 16:09:34}, priority = {0}, title = {Impact of repetitive episodes of antibody-mediated or cellular rejection on cardiovascular mortality in cardiac transplant recipients: defining rejection patterns.}, url = {http://dx.doi.org/10.1016/j.healun.2006.08.009}, volume = {25}, year = {2006} }

TY - JOUR ID - citeulike:1042942 L3 - citeulike-article-id:1042942 N2 - BACKGROUND: In our previously published work dealing with antibody-mediated (vascular) rejection (AMR), we defined patterns of rejection (AMR and cellular rejection [CR]) based on a review of biopsy diagnoses taken in the first 6 to 12 weeks post-transplant. We have shown the significance of these pattern designations in relation to patient and allograft outcome in five outcome analyses. The current retrospective analysis was done to determine whether our previous criteria for pattern designations provided the greatest degree of discrimination between AMR and CR. METHODS: Six hundred sixty-five patients from the U.T.A.H. Cardiac Transplant Program were included in our study. Patients induced with OKT3 immunosuppression were excluded. We analyzed the relationship of a number of either AMR or CR episodes to cardiovascular mortality. We constructed Kaplan-Meier survival curves to assess the impact of incremental numbers of AMR or CR episodes on cardiovascular mortality. RESULTS: Three or more episodes of AMR resulted in a statistically significant increase in cardiovascular mortality. By contrast, CR episodes did not increase the risk of cardiovascular mortality. CONCLUSIONS: Based on our findings, we believe that clinical trials should be designed to test treatments based on predominant rejection patterns and that end-points for trials should be defined by number of biopsies positive for either CR or AMR. This approach may lead to improved patient and allograft survival. IS - 11 JF - J Heart Lung Transplant SN - 1557-3117 AD - LDS Hospital, Intermountain Health Care, Salt Lake City, Utah 84143, USA. EP - 1282 TI - Impact of repetitive episodes of antibody-mediated or cellular rejection on cardiovascular mortality in cardiac transplant recipients: defining rejection patterns. VL - 25 SP - 1277 KW - biopsy KW - humoral KW - rejection AU - Kfoury, AG AU - Stehlik, J AU - Renlund, DG AU - Snow, G AU - Seaman, JT AU - Gilbert, EM AU - Stringham, JS AU - Long, JW AU - Hammond, ME PY - 2006/11// UR - http://dx.doi.org/10.1016/j.healun.2006.08.009 ER -