Antibody-mediated rejection 16 years post-cardiac transplantation: a case report of an uncommon late presentation in a middle-aged woman

European Heart Journal. Case Reports
Charles MillerMarwa Sabe

Abstract

Very late antibody-mediated rejection (AMR) in heart transplant patients (over 10 years post-transplant) is very rare. It is associated with high mortality, graft dysfunction, and fulminant coronary artery vasculopathy (CAV) and should remain in the differential for patients presenting with late graft dysfunction. A 57-year-old woman 16 years of post-heart transplant with a previously unremarkable post-transplant course including protocol driven biopsies showing no rejection and a recent unremarkable screening nuclear stress test presented to our institution with clinical heart failure. Echocardiogram revealed graft dysfunction and endomyocardial biopsy showed no signs of cellular rejection, but evidence of AMR. The patient was treated with steroid and immunotherapy with clinical improvement but suffered several infectious complications and renal dysfunction requiring haemodialysis related to her immunotherapy treatment. Despite aggressive AMR management, donor-specific antibodies and symptoms persisted and CAV progressed. This case illustrates the poor diagnostic yield of non-invasive testing for AMR, and highlights importance to clinicians of considering AMR even if the patient over 10 years post-transplant when the diagnosis...Continue Reading

References

Jun 18, 1998·American Heart Journal·J C FangG H Mudge
Dec 11, 2008·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·E RaichlinN L Pereira
Apr 4, 2015·Circulation·Monica M ColvinUNKNOWN American Heart Association Heart Failure and Transplantation Committee of the Council on Cardiovascular Surgery and Anesthes
May 10, 2015·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Guillaume CoutanceShaida Varnous
Jul 18, 2016·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Kevin J ClerkinDonna M Mancini

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biopsy
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