1. Does asymptomatic recurrent diffuse capillary C4d complement deposition impair cardiac allograft function?
- Author
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Frea S, Iacovino C, Botta M, De Filippi I, Mazzucco G, Pidello S, Biolè C, Bergerone S, Boffini M, Praticò Barbato L, Morello M, Rinaldi M, and Gaita F
- Subjects
- Adult, Aged, Asymptomatic Diseases, Biomarkers metabolism, Biopsy, Capillaries pathology, Echocardiography, Doppler, Female, Follow-Up Studies, Graft Rejection immunology, Graft Rejection pathology, Humans, Male, Middle Aged, Myocardium immunology, Myocardium pathology, Outcome Assessment, Health Care, Postoperative Complications diagnostic imaging, Prospective Studies, Recurrence, Transplantation, Homologous, Ventricular Dysfunction, Left diagnostic imaging, Capillaries immunology, Complement C4b metabolism, Graft Rejection complications, Graft Rejection diagnosis, Heart Transplantation, Peptide Fragments metabolism, Postoperative Complications etiology, Ventricular Dysfunction, Left etiology
- Abstract
Background: The aim of this study was to evaluate whether asymptomatic recurrent (≥2) antibody-mediated rejection (pAMR 1+), defined as diffuse capillary C4d immunostaining (rAMR) on endomyocardial biopsies (EMBs), during the first year after heart transplantation impairs left ventricular (LV) function., Methods: Fifty-four consecutive heart transplant patients who survived well (New York Heart Association ≤2 and EF≥55%) the first month after transplantation were enrolled and prospectively underwent 490 echocardiographies and EMB. Asymptomatic rAMR without histopathologic findings was evaluated as a risk factor for deterioration of graft function. Primary endpoint, assessed 1 year after transplantation, was development of LV dysfunction and/or adverse remodeling according to pre-specified echo parameters., Results: During the first year from transplantation, rAMR occurred in five patients. Recurrent AMR was associated with a significant higher risk to develop LV concentric hypertrophy (OR 3.6, 95% CI: 1.8-7.0, P=.02) or reduced lateral S' peak velocity (OR 2.3, 95% CI: 1.5-3.6, P=.03). Patients with rAMR showed significative adverse graft remodeling (ΔLV end-diastolic volume: +16±12.3 vs -0.2±14.4 mL; P=.02) and deterioration of graft function (Δlateral S' peak velocity: -3.3±3 vs -0.4±2.9 cm/s; P=.03)., Conclusions: Recurrent asymptomatic diffuse capillary C4d immunostaining may play a role in the early development of cardiac allograft adverse remodeling and dysfunction., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2016
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