Consequences of First-Year Rejection After Heart Transplantation: Is the Worse Yet to Come?

Tadwalkar, Rigved; Patel, Jignesh; Kittleson, M.; Czer, L.; Kobashigawa, J.A.

doi:10.1016/s0735-1097(12)60993-0

Cited by 1 publication

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“…AMR was recognized as pathologically distinct from CR over 20 years ago, but its incidence and importance have increased as CR rates have declined and more patients with circulating anti-HLA antibodies undergo transplantation [18,19]. This form of rejection is most common in the first year after transplantation, occurring in approximately 6.5% of patients [20,21]. AMR occurs when anti bodies against HLA antigens, present either before or formed after transplant, bind to the allograft and activate complement, leading to tissue injury.…”

Section: Future Science Groupmentioning

confidence: 99%

“…Overall, the short-term outcome for patients with symptomatic CR, even with high-grade rejection, is good [23]. However, patients experiencing CR within the first year after transplant tend to develop coronary allograft vasculopathy with higher frequency and at an earlier time than those without CR [20,24]. By contrast, CR with hemodynamic compromise, often requiring inotropes or mechanical circulatory support, only occurs in between 4 and 6% of patients by the end of the first year post-transplant, but is associated with a high mortality (40% by 1 year) [9,25].…”

Section: Future Science Groupmentioning

confidence: 99%

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Genetic and Genomic Approaches to the Detection of Heart Transplant Rejection

Kransdorf

Kobashigawa

2012

Personalized Medicine

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Since Christiaan Barnard performed the first heart transplant in 1967, over 100,000 heart transplants have been performed worldwide. As was true then, rejection remains the major threat to the function and survival of the allograft. The development of the endomyocardial biopsy as a means to monitor for rejection has allowed heart transplantation to thrive as a therapy for patients with end-stage heart disease. The need for a noninvasive method of rejection surveillance led to the development of the first genetic test for allograft rejection, the AlloMap. In this article, after presenting the pathological and clinical features of cardiac allograft rejection, the authors discuss the development and application of gene-expression testing for the detection of cardiac allograft rejection. We then explore emerging 'omic' approaches that will be the rejection detection methods of the future.

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Section: Future Science Groupmentioning

confidence: 99%