Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation.

Abstract

BACKGROUND:

Single-center data suggest that the index of microcirculatory resistance (IMR) measured early after heart transplantation predicts subsequent acute rejection.

OBJECTIVES:

The goal of this study was to validate whether IMR measured early after transplantation can predict subsequent acute rejection and long-term outcome in a large multicenter cohort.

METHODS:

From 5 international cohorts, 237 patients who underwent IMR measurement early after transplantation were enrolled. The primary outcome was acute allograft rejection (AAR) within 1 year after transplantation. A key secondary outcome was major adverse cardiac events (MACE) (the composite of death, re-transplantation, myocardial infarction, stroke, graft dysfunction, and readmission) at 10 years.

RESULTS:

IMR was measured at a median of 7 weeks (interquartile range: 3-10 weeks) post-transplantation. At 1 year, the incidence of AAR was 14.4%. IMR was associated proportionally with the risk of AAR (per increase of 1-U IMR; adjusted hazard ratio [aHR]: 1.04; 95% confidence interval [CI]: 1.02-1.06; p < 0.001). The incidence of AAR in patients with an IMR ≥18 was 23.8%, whereas the incidence of AAR in those with an IMR <18 was 6.3% (aHR: 3.93; 95% CI: 1.77-8.73; P = 0.001). At 10 years, MACE occurred in 86 (36.3%) patients. IMR was significantly associated with the risk of MACE (per increase of 1-U IMR; aHR: 1.02; 95% CI: 1.01-1.04; P = 0.005).

CONCLUSIONS:

IMR measured early after heart transplantation is associated with subsequent AAR at 1 year and clinical events at 10 years. Early IMR measurement after transplantation identifies patients at higher risk and may guide personalized posttransplantation management.

• Authors: Jung-Min Ahn, Frederik M Zimmermann, Lars Gullestad, Oskar Angerås, Kristjan Karason, Kristoffer Russell, Ketil Lunde, Kozo Okada, Helen Luikart, Kiran K Khush, Yasuhiro Honda, Nico H J Pijls, Sang Eun Lee, Jae-Joong Kim, Seung-Jung Park, Ole-Geir Solberg, William F Fearon
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 78 Issue 24 Pg. 2425-2435 (12 14 2021) ISSN: 1558-3597 [Electronic] United States
• PMID: 34886963 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Published by Elsevier Inc.

Topics

• Allografts
• Coronary Angiography
• Coronary Circulation (physiology)
• Female
• Follow-Up Studies
• Graft Rejection (diagnosis, physiopathology)
• Heart Transplantation (adverse effects)
• Humans
• Male
• Microcirculation (physiology)
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Time Factors
• Vascular Resistance (physiology)