The influence of donor-related factors on the frequency of acute cellular rejection by the recipient in the first year following heart transplantation.

BACKGROUND

This study was an attempt to identify donor-related factors influencing the frequency of acute cellular rejection episodes in cardiac transplant recipients in the first year following transplantation.

MATERIAL/METHODS: The study encompassed 76 patients (14 women and 62 men) aged 6-68 years, mean 47.8+/-16.3, who received a cardiac transplant at the Institute of Cardiology in Warsaw between 2001-2005. The period of observation was from day 7 after transplantation (the day of the first biopsy by protocol) to the end of the first year. Follow-up at the outpatient department included physical examination, echocardiography, blood biochemistry and determination of circulating levels of immunosuppressive drugs. Endomyocardial biopsies were obtained and evaluated according to ISHLT criteria. The study was conducted according to the following biopsy schedule: every 7 days in the first month, every 14 days in the second, and every three months from month three to the end of the first year. The frequency of acute cellular rejection was assessed along with potential donor-related factors (age, gender, donor cause of death). The study protocol was approved by the Local Bioethics Committee of the Institute of Cardiology. Comparative statistical analysis was conducted retrospectively using the Mann-Whitney and Kruskal-Wallis tests.

RESULTS

A total of 39 abnormal biopsies were found (degree 2 and 3 ISHLT) among the 750 biopsies performed (5.2%). No significant differences were found in the number of acute cellular rejection episodes in relation to treatment protocol and blood cyclosporine concentration in the studied period. Acute cellular rejection was occured significantly more frequently when intracerebral hemorrhage was the donor's cause of death (p<0.0131) and showed a tendency to occur more frequently when the donor was female (p<0.0611). The effects of donor age, blood type and duration of ischemia were not significant.

CONCLUSIONS

Significantly more episodes of acute cellular rejection occur in recipients of hearts from donors who died from intracerebral hemorrhage. A trend towards more frequent episodes of acute cellular rejection appears when the donor was female.