Introduction and objectives: Acute rejection is still a common cause of death after heart transplantation, in spite of cyclosporine. The aim of our study was to assess the incidence of severe graft dysfunction associated with acute rejection and the short and long-term outcome of these patients.
Methods: Ten of our 100 first heart transplant patients have developed rejection-induced severe cardiac dysfunction (left ventricular ejection fraction determined by echocardiography < 35% associated with 3A, 3B or 4 acute rejection). Clinical outcome, complications and evolution of left ventricular function were studied.
Results: Five patients were given intravenous methylprednisolone 500 to 1000 mg/day for 3 days. The other 5 patients had severe heart failure and received antilymphocyte antibodies. Three patients treated with methylprednisolone alone and one patient treated with antilymphocyte antibodies died within the first week after therapy. Left ventricular ejection fraction increased from 26 +/- 4% to 51 +/- 6% at 1 month after therapy in the 6 survivor patients. Four of the 6 survivor patients also died before 1 year after rejection (3 due to infection). Thus, long-term, overall mortality was 80%.
Conclusions: Although favorable short-term results can be achieved in patients with rejection-induced severe cardiac dysfunction with immunosuppressive therapy (mainly antilymphocyte antibodies), long-term prognosis seems poor, due to the increased rate of life-threatening infections.