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Acute cardiac allograft rejection: Treatment

Howard J Eisen, MD
Section Editor
Sharon A Hunt, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Despite the use of potent immunosuppressive agents both immediately after cardiac transplantation and during long-term maintenance, acute rejection remains an important problem. The incidence of any rejection between discharge and one year has decreased from 30 percent for primary transplants in 2004 to 2006 to 25 percent in 2010 to 2011 [1]. Acute cellular rejection is most likely to occur in the first three to six months, with the incidence declining significantly after this time [2].

The diagnosis of acute cellular cardiac allograft rejection is generally made by endomyocardial biopsy performed either routinely or because of suggestive symptoms.

ISHLT grading system — The endomyocardial biopsy is graded using the International Society for Heart and Lung Transplantation (ISHLT) nomenclature adopted in 1990 and revised in 2004 [3-5]. For acute cellular rejection [5]:

Grade 0 – No rejection

Grade 1 R, mild – Interstitial and/or perivascular infiltrate with up to one focus of myocyte damage

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Literature review current through: Oct 2017. | This topic last updated: May 10, 2017.
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