Acute rejection timing in the first post-transplant year is not associated with incident cardiac allograft vasculopathy
Butler, B.; Huang, S.; Rali, A. S.; Siddiqi, H. K.; Menachem, J. N.; Chow, N.; Farber-Eger, E.; Wells, Q. S.; Schlendorf, K. H.; Amancherla, K.
Show abstract
Heart transplantation (HT) is the durable therapy for end-stage heart failure (HF). Despite advances in immunosuppression, cardiac allograft vasculopathy (CAV) remains a leading cause of late graft failure and mortality in the modern era. Prior studies have established donor age and immunological phenomena, such as acute cellular rejection (ACR), antibody-mediated rejection (AMR), and development of donor-specific antibodies (DSAs) as risk factors for CAV. However, it remains unclear whether acute rejection (AR) that occurs early post-HT, when individuals experience the highest degree of immunosuppression, reflects higher baseline immune activity and confers a higher risk of future CAV compared to later AR, when immunosuppression is minimized. We therefore examined whether AR occurring during pre-specified early and intermediate intervals compared to those who did not experience AR in the first post-HT year was associated with future CAV among recipients without CAV at 1 year.
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