Humoral Heart Rejection (Severe Allograft Dysfunction with no Signs of Cellular Rejection or Ischemia): Incidence, Management, and the Value of C4d for Diagnosis
Key result
Plasmapheresis drives recovery in ~92% of heart transplant humoral rejection cases diagnosed by C4d testing.
- n=445
Why the study?
Severe allograft dysfunction after heart transplant without ischemia or cellular rejection is rare and its incidence, diagnosis, and management remain uncertain.
Population
445 heart transplant patients from April 1991 to December 2003
Comparison
Immunofluorescence testing for C4d vs classical IF markers; treatment with steroids and plasmapheresis
Design
Retrospective observational study
Authors
Discussion
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Member takes
Implication
HR diagnosis in HT warrants caution with conventional criteria alone; leaves open optimal immunopathologic standards for future validation.
Study Design
Type
Observational (n=445)
Structured PICO
P
Population
445 heart transplant patients evaluated retrospectively to determine the incidence of humoral rejection and the diagnostic value of C4d.
E
Exposure
Immunofluorescence testing for C4d on endomyocardial biopsy tissue; treatment with high-dose steroids and plasmapheresis for humoral rejection
O
Outcome
Incidence of humoral rejection, diagnostic utility of C4d, and clinical response to plasmapheresis and steroids
Humoral rejection is a rare (<3%) complication after heart transplantation that responds well to plasmapheresis, and C4d staining is a useful diagnostic marker.
Cite This Study
Crespo‐Leiro et al. (2005) conducted an observational in Heart transplant (n=445). Humoral rejection was evaluated on Incidence of humoral rejection. Humoral rejection was observed in 2.7% of heart transplant patients, with C4d testing proving useful for diagnosis and plasmapheresis resulting in successful recovery in 11 of 12 cases.