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• W3136347555 abstract "PurposeImmunodeficiency increasing risk for immune-mediated disease is common in primary immunodeficiency diseases. Also, solid organ transplants are major sources of chronic antigen stimulation. Thus, we aimed to investigate new-onset immune mediated disease (NOIMD) after heart transplantation (HT) and its implications on outcomes.MethodsWe performed a retrospective analysis of 196 adult HT recipients transplanted between 2000 and 2019 for whom data regarding immune mediated disease were available. Endpoints included early (primary graft dysfunction and 30-day mortality) and late outcomes.ResultsA definitive diagnosis of NOIMD was made for 20 (10.2%) recipients, and there was a suspicion of NOIMD for an additional 17 (8.6%). Baseline characteristics and immunosuppressants were similar for the definite NOIMD and no NOIDM groups. The meantime between transplant and a diagnosis of NOIMD was 5.5 (6.0) years. No differences between the two groups were observed in early outcomes. Rates of new-onset diabetes, renal failure, and hypertension post-transplant were similar for the two groups, as were survival and cardiac allograft vasculopathy (CAV). Treated rejection at one year and clinical CMV disease (42.1 vs 16.1%, p=0.016) were higher for the NOIMD group. The rate of donor-specific antibodies (DSAs) was significantly higher for NOIMD patients (45.5 vs 1.9%, p<0.001). In multivariable analysis (Figure), de-novo DSAs were independently associated with a significantly higher risk of NOIMD.ConclusionHT is frequently associated with immune-mediated disease development, manifested by a twofold increased risk vs the non-transplant population. Further study is needed to determine how the altered immune system contributes to developing the autoimmune disease. The delineation of specific immune derangements would enable proactive evaluation and screening of the T cell compartment before and after HT, allowing for modification of immunosuppression regimes in an attempt to decrease the risk. Immunodeficiency increasing risk for immune-mediated disease is common in primary immunodeficiency diseases. Also, solid organ transplants are major sources of chronic antigen stimulation. Thus, we aimed to investigate new-onset immune mediated disease (NOIMD) after heart transplantation (HT) and its implications on outcomes. We performed a retrospective analysis of 196 adult HT recipients transplanted between 2000 and 2019 for whom data regarding immune mediated disease were available. Endpoints included early (primary graft dysfunction and 30-day mortality) and late outcomes. A definitive diagnosis of NOIMD was made for 20 (10.2%) recipients, and there was a suspicion of NOIMD for an additional 17 (8.6%). Baseline characteristics and immunosuppressants were similar for the definite NOIMD and no NOIDM groups. The meantime between transplant and a diagnosis of NOIMD was 5.5 (6.0) years. No differences between the two groups were observed in early outcomes. Rates of new-onset diabetes, renal failure, and hypertension post-transplant were similar for the two groups, as were survival and cardiac allograft vasculopathy (CAV). Treated rejection at one year and clinical CMV disease (42.1 vs 16.1%, p=0.016) were higher for the NOIMD group. The rate of donor-specific antibodies (DSAs) was significantly higher for NOIMD patients (45.5 vs 1.9%, p<0.001). In multivariable analysis (Figure), de-novo DSAs were independently associated with a significantly higher risk of NOIMD. HT is frequently associated with immune-mediated disease development, manifested by a twofold increased risk vs the non-transplant population. Further study is needed to determine how the altered immune system contributes to developing the autoimmune disease. The delineation of specific immune derangements would enable proactive evaluation and screening of the T cell compartment before and after HT, allowing for modification of immunosuppression regimes in an attempt to decrease the risk." @default.
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• W3136347555 date "2021-04-01" @default.
• W3136347555 modified "2023-10-16" @default.
• W3136347555 title "New-Onset Immune Mediated Disease after Heart Transplantation: Characterization and Outcomes" @default.
• W3136347555 doi "https://doi.org/10.1016/j.healun.2021.01.694" @default.
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