Patients with humoral graft rejection showed normal myocardial strain values on average one year before the rejection episode and then presented with progressive decline of global longitudinal strain and circumferential strain in the months preceding acute graft rejection. This was in contrast to controls and cellular graft rejection patients, who had stable strain values except for the moment of acute graft rejection.
Left ventricular ejection fraction and other conventional echocardiography measurements did not significantly change in the months prior to an acute graft rejection episode and could not differentiate between the three groups.
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Dr Cordeiro said: “This study demonstrates a progressive decrease of global longitudinal strain and circumferential strain months before a humoral graft rejection becomes clinically apparent. Such alterations months before a severe graft rejection are not evident with conventional echocardiographic parameters and do not occur in cellular graft rejection.”
The researchers believe the observed differences between the two types of graft rejection are due to differing pathophysiology. Cellular graft rejection is an acute T cell mediated process while humoral graft rejection develops when the recipient develops antibodies against the donor.
Dr Cordeiro said: “Humoral graft rejection is a major limitation to long-term graft survival. Our data suggests that global strain assessment by echocardiography allows early detection of a developing humoral graft rejection. This could trigger maintenance immunosuppressive therapy optimisation, increased surveillance or acute treatment and prevent progression to graft failure.”
References and notes
1The abstract ‘Global longitudinal strain decreases months before acute humoral but not before acute cellular rejection episode in heart transplant recipients’ will be presented during the Young Investigator Award session – Clinical Science – The Roelandt’s Young Investigator Award on 7 December at 15:30 to 16:30 in the Agora.
2Severe cellular graft rejection was defined as grade 3R or higher of the International Society of Heart and Lung Transplantation classification in the endomyocardial biopsy that required steroid treatment. Severe humoral graft rejection was defined as those with circulating anti-donor antibodies and positive C4d (a complement fraction) at the endomyocardial biopsy that required treatment with intravenous immunoglobulin and rituximab.
