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Prognostic significance of recurrent grade 1B rejection in the first year after pediatric cardiac transplantation: A case for reinstatement of the 1B rejection grade
Author(s) -
Feingold Brian,
Irving Claire,
Tatum Gregory H.,
Webber Steven A.
Publication year - 2011
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2011.01530.x
Subject(s) - medicine , univariate analysis , biopsy , single center , transplantation , proportional hazards model , grading (engineering) , surgery , multivariate analysis , heart transplantation , statistical significance , civil engineering , engineering
Feingold B, Irving C, Tatum GH, Webber SA. Prognostic significance of recurrent grade 1B rejection in the first year after pediatric cardiac transplantation: A case for reinstatement of the 1B rejection grade.
Pediatr Transplantation 2011: 15: 589–593. © 2011 John Wiley & Sons A/S. Abstract: The 2005 ISHLT rejection grading system merged grades 1A, 1B, and 2 into a single grade (1R) assuming equivalent prognostic significance. We hypothesized that recurrent 1B ACR is associated with adverse outcomes. Data on all heart transplant recipients at our center from 1990 to 2007 were reviewed. Patients were excluded if they had more than one grade ≥3A/2R biopsy in the first six wk or any grade ≥3A/2R biopsies during the first year thereafter. Patients with ≥2 grade 1B biopsies from six wk to one yr were classified as “recurrent 1B.” Outcomes were freedom from late (greater than one yr) ACR (grade ≥3A/2R), CAD, retransplantation/death, and a composite end‐point. Sixty‐two patients (53 non‐recurrent 1B, nine recurrent 1B) met inclusion criteria. In univariate analyses, recurrent 1B status was associated with decreased freedom from late ACR (p < 0.001), CAD (p = 0.004), and the composite outcome (p < 0.001). There was no difference in freedom from retransplantation/death (p = 0.48). After controlling for demographic differences between the groups, recurrent 1B status was independently associated with late ACR (HR 5.90; p = 0.002) and the composite outcome (HR 4.52; p = 0.002). These data suggest that further study of the impact of removal of the 1B classification from the ISHLT grading scheme is warranted.