Hypersensitivity Myocarditis before Heart Transplantation Is Associated with Increased Acute Cellular Rejection after Transplantation
Saeko K Yoshizawa, Tomoko S Kato, Donna Mancini, Charles C Marboe. Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY
Background: Hypersensitivity myocarditis (HSM) is associated with the use of multiple drugs, and has been occasionally observed in the patients with end-stage heart failure. However, whether or not HSM at the time of heart transplantation (HTx) affects long-term prognosis including acute cellular rejection (ACR) and antibody-mediated rejection (AMR) after HTx remains unclear. This study addresses the occurrence, clinical and pathological characteristics, and prognosis of patients with HSM at HTx.
Design: 766 consecutive patients who underwent de-novo HTx at Columbia University Medical Center between 2000 and 2010 were retrospectively reviewed. Clinical characteristics and pathological findings of patients with pre-HTx HSM diagnosed by histological evaluation of the explanted heart were analyzed. Prognosis after HTx was compared between the patients with or without HSM.
Results: HSM was observed in 21 patients (2.7%). The rate of pre-HTx HSM in our hospital has been decreasing during the study period in inverse relation to the rate of left ventricular assist device implantation before transplant. 19 patients (90%) had peripheral blood eosinophilia at the time of HTx, but in no case was HSM clinically diagnosed. Dobutamine, a common cause of HSM, was administrated in 12 patients (57%). All patients had varying degrees of mixed inflammatory infiltrates with eosinophils, lymphocyte, macrophages, and plasma cells, but none of the patients showed myocardial necrosis. The number of episodes of biopsy diagnosed ACR (ISHLT grade ≥2R) was 11 (3.9%) in HSM patients and 197 (2.2%) in patients without HSM (p=0.06) during the first year post-HTx, and 11 (3.8%) in HSM patients and 78 (1.5%) in patients without HSM (p=0.006) after second year post-HTx. Regarding AMR, there was no statistically significant difference between the groups throughout the study period. Post-transplant survival did not differ in patients with or without pre-transplant HSM.
Conclusions: HSM at the time of HTx is associated with an increased frequency of late ACR after HTx. Post-HTx survival is not influenced by pre-transplant HSM.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 52, Wednesday Morning