Three-Dimensional Self-Navigated T2 Mapping for the Detection of Acute Cellular Rejection After Orthotopic Heart Transplantation

The use of alemtuzumab for induction therapy in orthotopic heart transplantation remains controversial, despite its observed benefits in other transplant populations. This study aimed to evaluate whether alemtuzumab conferred a lower risk of rejection while reducing toxicities commonly attributed to standard immunosuppression in orthotopic heart transplantation. We included adult patients who underwent orthotopic heart transplantation and received induction therapy with alemtuzumab (n = 26) or standard immunosuppression (n = 26). The primary end point was freedom from grade ≥2 rejection at 12 months. Baseline characteristics were similar between the groups with the exception of poorer renal function in the alemtuzumab group ( P < .05). The primary end point of freedom from grade ≥2 rejection at 12 months was not different between alemtuzumab and standard therapy (76.9% vs 96.2%, P = .077), likely due to similarities in the rates of antibody-mediated rejection in the 2 groups. However, grade ≥2 acute cellular rejection was considerably lower with alemtuzumab (0% vs 19.2%, P = .02), as was acute cellular rejection of any severity (50% vs 7.7%, P = .004). Deterioration in renal function was significantly greater among patients receiving standard therapy as evidenced by decreases in glomerular filtration rate (−25.6 vs −9.2 mL/min, P = .032). No differences in hematologic or infectious complications were observed. In conclusion, alemtuzumab reduced several important rejection-related outcomes while ameliorating the toxicities associated with standard immunosuppression therapy, making it a promising agent for induction in orthotopic heart transplantation.

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Correction to: Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation

Cardiovascular Ultrasound ◽

10.1186/s12947-021-00241-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Cecilia Beatriz Bittencourt Viana Cruz ◽

Ludhmila A. Hajjar ◽

Fernando Bacal ◽

Marco S. Lofrano-Alves ◽

Márcio S. M. Lima ◽

...

Keyword(s):

Heart Transplantation ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Acute Cellular Rejection ◽

Cellular Rejection

An amendment to this paper has been published and can be accessed via the original article.

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Comparative Analysis of Distribution of Acute Cellular Rejection and Antibody-Mediated Rejection With Emphasis on Time After Heart Transplantation in Two European Transplant Centers

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2015.01.900 ◽

2015 ◽

Vol 34 (4) ◽

pp. S318

Author(s):

K. Wassilew ◽

T. Haberl ◽

A. Zuckermann ◽

K. Aumayr

Keyword(s):

Comparative Analysis ◽

Heart Transplantation ◽

Acute Cellular Rejection ◽

Antibody Mediated Rejection ◽

Cellular Rejection

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Usefulness of Speckle Tracking Echocardiography and Biomarkers for Detecting Acute Cellular Rejection After Heart Transplantation

10.21203/rs.3.rs-96047/v1 ◽

2020 ◽

Author(s):

Cecília Beatriz Bittencourt Viana Cruz ◽

Ludhmila A. Hajjar ◽

Fernando Bacal ◽

Marco S. Lofrano-Alves ◽

Márcio S.M. Lima ◽

...

Keyword(s):

Heart Transplantation ◽

Right Ventricular ◽

Speckle Tracking ◽

Troponin I ◽

Speckle Tracking Echocardiography ◽

Left Ventricular ◽

Acute Cellular Rejection ◽

Control Group ◽

Transplant Patients ◽

Cellular Rejection

Abstract Background: Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation.Methods: We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance six months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. Results: Among the included 60 patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 – 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 21.4%± 3.2% vs 16.6% ± 2.9%, p<0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09–1.31) vs. 0.05 ng/mL (0.01–0.18), p=0.007]. The combination of troponin with LV-GLS, RV FWLS and LV-Twist had an AUC (area under curve) for the detection of ACR of 0.80 (0.68 – 0.92), 0.89 (0.81 – 0.93) and 0.79 (0.66 – 0.92), respectively. Conclusion: Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.

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