ISHLT pathology antibody mediated rejection score correlates with increased risk of cardiovascular mortality: A retrospective validation analysis

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• 作者：M. Elizabeth H. Hammond ; MD^a ; ^b ; ^c ; ^{liz.hammond@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Monica P. Revelo ; MD ; PhD^b ; ^c ; Dylan V. Miller ; MD^a ; ^b ; ^c ; Gregory L. Snow ; PhD^d ; Deborah Budge ; MD^a ; ^e ; Josef Stehlik ; MD^a ; ^f ; ^h ; Kimberly M. Molina ; MD^a ; ⁱ ; Craig H. Selzman ; MD^a ; ^g ; Stavros G. Drakos ; MD ; PhD^a ; ^f ; Alharethi Rami A. ; MD^a ; ^e ; Jose N. Nativi-Nicolau ; MD^a ; ^f ; Bruce B. Reid ; MD^a ; ^e ; Abdallah G. Kfoury ; MD^a ; ^e
• 关键词：antibody-mediated rejection ; clinical ; heart transplantation ; pathology ; cardiovascular mortality
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：35
• 期：3
• 页码：320-325
• 全文大小：458 K

文摘

Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection with adverse patient outcomes. The International Society of Heart and Lung Transplantation (ISHLT) has published a consensus schema for the pathologic diagnosis of various grades of antibody-mediated rejection (pathology antibody-mediated rejection [pAMR]). We sought to determine whether the ISHLT pAMR grading schema correlates with patient outcomes.

Methods

Using our database, which contains a semi-quantitative scoring of all pathologic descriptors of pAMR, we retrospectively used these descriptors to convert the previous AMR categories to the current ISHLT pAMR categories. Cox proportional hazard models were fit with cardiovascular (CV) death or retransplant as the outcome. The pAMR value was included as a categorical variable, and cellular rejection (CR) values were included in a separate model.

Results

There were 13,812 biopsies from 1,014 patients analyzed. The pAMR grades of pAMR1h, pAMR1i, and pAMR2 conferred comparable increased risk for CV mortality. Significantly increased risk of CV mortality was conferred by biopsies graded as severe AMR (pAMR3).

Conclusions

The new ISHLT pAMR grading schema identifies patients at increased risk of CV mortality, consistent with risks published from several programs before 2011. The current schema is validated by this analysis in a large biopsy database. Because pAMR1h, pAMR1i, and pAMR2 have similar CV risks associated with them, the threshold for a positive diagnosis of pAMR should be re-evaluated in future iterations of the ISHLT schema.