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Antibody‐mediated rejection induced cardiogenic shock: Too late for conventional therapy
Author(s) -
Coutance Guillaume,
Van Aelst Lucas,
Hékimian Guillaume,
Vidal Charles,
Rouvier Philippe,
Saheb Samir,
Gautreau Chantal,
Leprince Pascal,
Varnous Shaida
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13253
Subject(s) - medicine , cardiogenic shock , subclinical infection , heart transplantation , biopsy , retrospective cohort study , observational study , transplantation , surgery , shock (circulatory) , cardiology , myocardial infarction
Background Data are scarce on the prognosis of heart allograft antibody‐mediated rejection ( AMR ) with cardiogenic shock ( CS ). Methods We performed a retrospective, single center, observational study. We included patients with biopsy‐proven AMR and CS . We aimed to analyze the characteristics, treatment, and prognosis of patients treated for CS due to AMR . Patients alive after AMR were followed to analyze recurrences of AMR , graft function, and cardiac allograft vasculopathy ( CAV ). Results Seventeen patients met the inclusion criteria. Patients were mostly males (70%). Median age at diagnosis was 56 years, and median time between heart transplantation and AMR was 21 months. AMR was mostly due to high‐level de novo class II DSA . Only 2 patients had past history of biopsy‐proven AMR . Despite aggressive immunosuppressive therapies, in‐hospital and 1‐year mortality were as high as 76% and 82%, respectively. Four patients were discharged from hospital. Two of them were diagnosed with recurrent subclinical AMR : one died suddenly and the other presented rapidly progressive CAV . Conclusion CS due to AMR occurred mostly in patients without history of AMR who developed de novo class II DSA . Despite aggressive conventional immunosuppressive therapies, prognosis after CS due to AMR was poor.