Incidence of suspected humoral rejection in heart transplant recipients

Heart transplant recipients (HTR) can experience hemodynamic compromise due to suspected acute allograft rejection without evidence of cellular rejection commonly referred to as suspected "humoral" rejection (SHR). To review our treatment outcome of SHR, we retrospectively reviewed medical records of 264 HTR transplanted between 9/91 to 9/00. Thirty-two HTR were diagnosed and treated for SHR associated with hemodynamic compromise defined as a decline in cardiac index (CI) by 25% from baseline, new wall motion abnormalities, restrictive abnormalities or cardiac arrest with. proven tissue diagnosis. All HTR at the time of SHR had low grade the endomyocardial biopsy results (EMBR). One-year, and three-year post-SHR survivals were 24/32 (75.0%) and 17/28 (60.7%). One-year and three-year post-HT survivals were 29/32 (90.6%) and 19/28 (67.9%). Our data demonstrate that the incidence of SHR was as high as 15.5% in HTR. Although, once SHR was diagnosed, the aggressive augmentation of immunosuppression rapidly improved and sustained left ventricular function in the majority of surviving HTR.