HEART TRANSPLANTATION AT ALLEGHENY GENERAL S Hsia and P Olson, De

HEART TRANSPLANTATION AT ALLEGHENY GENERAL.
S Hsia and P Olson, Department of Pathology & Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA.

Data on the histocompatibility testing (HT) and endomyocardial biopsies (EMB) from 100 transplants were collected. The longest follow-up time was over 8 years. HT data showed the majority (87%) of these recipients had cardiomyopathies. The mean recipient age was 51.72"8.1 years. Only two recipients had a serum percent reactive antibody of >10% and they were crossmatched with donor lymphocytes prospectively. The remaining donor-recipient (D-R) pairs were crossmatched retrospectively. The mean donor age was 29.08"11.02 years and the mean donor organ cold ischemic time was 2.68"1.0 hours. Overall, 1 and 5 years graft survival time (GST) were 87% and 77% respectively and was 69% by the 8th year post-transplantation. The mean GST (MGST, Kaplan-Meier statistics) was 6.83"4.39 years. Scores based on 0-6 possible HLA-A, B, DR antigen mismatches (MM) of D-R pairs gave a mean MM score of 4.32"1.2. No significant difference in MGSTs was found (P = 0.30). Using the UNOS cross reactive antigen groups (CREG) scheme, a mean CREG MM score of 3.30"1.27 was obtained. Recipients with less CREG MM scores (<4) had borderline significant longer graft survival than those with MM scores of >4 (MGSTs: 87.7"4.7 vs 67.1"10.0 months, P=0.05). Those recipients receiving a graft from the donor with no detectable serum cytomegalovirus antibodies had significant longer MGSTs than those from the donor with detectable antibodies (MGSTs: 96.7"4.9 vs 76.1"6.2 P=0.03). No significant difference in MGSTs was found with factors such as recipient or donor age, race (Caucasian vs African American), gender and ABO blood group matching (exact vs universal, P>0.30). A total of 2,096 EMB samples from 92 recipients were reviewed using the ISHLT grading scores. Since both clinical symptoms and biopsy results were used for determining immunosuppressive dosage, equitable MGSTs were found for those with less or greater tissue rejection patterns (<3a grade: 87.3"4.9 and >3a grade: 89.2"7.5 months of MGSTs, P=0.77). We have thus provided an effective treatment for patients with end stage heart diseases in a low volume program like this one.