A reevaluation of the role of IgM Non-HLA antibodies in cardiac transplantation.

Background: Preexisting IgG antibodies to donor human leukocyte antigens (HLA) are a risk factor for rapid allograft rejection. However, non-HLA antibodies, of the IgM class, also called autoreactive antibodies, are not believed to affect graft survival. The aim of this study was to determine the incidence and clinical relevance of pretransplant lymphocytotoxic non-HLA IgM antibodies on long-term cardiac allograft survival.

Chronic kidney disease after heart transplantation.

Background: Chronic kidney disease (CKD) is a complication of heart transplantation related to calcineurin inhibitor nephrotoxicity. However, it is unclear whether early ciclosporin (CsA) exposure influences CKD in the long term.

Methods: We analysed risk factors for CKD in 352 patients who underwent orthotopic heart transplantation (1995-2005).

Limited utility of endomyocardial biopsy in the first year after heart transplantation.

Background: Surveillance endomyocardial biopsies (EMBs) are used for the early diagnosis of acute cardiac allograft rejection. Protocols became standardized in an earlier era and their utility with contemporary immunosuppression has not been investigated.

Methods: We studied 258 patients after orthotopic heart transplantation comparing 135 patients immunosuppressed by mycophenolate mofetil (MMF) with 123 patients treated by azathioprine (AZA); both with cyclosporine and corticosteroids after induction therapy with rabbit antithymocyte globulin.

Mycophenolate mofetil may allow cyclosporine and steroid sparing in de novo heart transplant patients.

Background: Mycophenolate mofetil (MMF) provides superior prophylaxis against acute rejection when compared with azathioprine (AZA) in heart and renal transplantation. However, it remains unclear whether this results in improved survival or reduced morbidity after heart transplantation.

Method: In a sequential study, 240 cardiac transplant patients were treated with either MMF (n=119) or AZA (n=121) both in combination with cyclosporine and corticosteroids after rabbit antithymocyte globulin induction.

Reversible sirolimus-associated pneumonitis after heart transplantation.

Sirolimus (rapamycin) and everolimus are immunosuppressive agents that inhibit cardiac allograft vasculopathy. Sirolimus has been widely used in renal transplantation, and its use in heart transplantation is increasing. Sirolimus-associated pneumonitis has been described in renal transplant patients.